Individual
GRACE OGHALE OSIEZAGHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5549 MCCROSSIN CIR, LITHONIA, GA 30038-4801
(404) 917-5112
(770) 323-7512
Mailing address
5549 MCCROSSIN CIR, LITHONIA, GA 30038-4801
(404) 917-5112
(770) 323-7512
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
GA
172V00000X
Community Health Worker
—
GA
174H00000X
Health Educator
—
GA
175T00000X
Peer Specialist
—
GA
251E00000X
Home Health Agency
Primary
—
GA
251S00000X
Community/Behavioral Health Agency
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1066260
HEALTH EDUCATION
GA
01
—
263534
BFTS
GA
01
—
886674697
NASW
GA
01
—
CN0028834263
CNA
GA
Enumeration date
09/10/2018
Last updated
09/10/2018
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