Provider Demographics
NPI:1730454364
Name:MARCUM, IJUNANYA OKWUCHI
Entity type:Individual
Prefix:MS
First Name:IJUNANYA
Middle Name:OKWUCHI
Last Name:MARCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IJUNANYA
Other - Middle Name:OKWUCHI
Other - Last Name:MARCUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28842 BURNING TREE LN
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3004
Mailing Address - Country:US
Mailing Address - Phone:313-719-8080
Mailing Address - Fax:
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:BUILDING 4 ENTRANCE F
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7701
Practice Address - Fax:734-287-4602
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI4703126099164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health