Individual
HENRIETTA EGBUNIKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2711 IRVIN WAY STE 201, DECATUR, GA 30030-1724
(866) 523-4268
Mailing address
100 CHASELAKE DR, JONESBORO, GA 30236-7712
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15707454
CAQH
GA
Enumeration date
06/29/2016
Last updated
11/02/2022
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