Provider Information for 1841803780
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Mrs. ALISA REBECCA DENILSON IKENWUDE LPC
Other Names:Former Name:ALISA REBECCA CLEMONS LPCSex: Female
NPI: 1841803780
Last Updated: 2022-10-13
Certification Date: 2022-10-13
Certification Date: 2022-10-13
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1841803780 | ||||||||||||
| Enumeration Date | 2020-08-30 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 29155 NORTHWESTERN HWY #652 SOUTHFIELD, MI 48034 United States Phone: 284-890-5807 | Fax: | ||||||||||||
| Primary Practice Address | AL THANYA STREET 685, BUILDING 163, ZONE 54, FLAT 6 MEHAIRJA, DOHA 00000 Qatar Phone: 974-316-1274 | Fax: | ||||||||||||
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