Provider Demographics
NPI:1851287601
Name:MBANGA, GODLOVE ACHU
Entity type:Individual
Prefix:MR
First Name:GODLOVE
Middle Name:ACHU
Last Name:MBANGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17923 LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2733
Mailing Address - Country:US
Mailing Address - Phone:917-564-4610
Mailing Address - Fax:
Practice Address - Street 1:17923 LESLIE RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2733
Practice Address - Country:US
Practice Address - Phone:917-564-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)