Provider Demographics
NPI:1548488257
Name:OKORIE, BENNETH I
Entity type:Individual
Prefix:MR
First Name:BENNETH
Middle Name:I
Last Name:OKORIE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BENNETH
Other - Middle Name:I
Other - Last Name:OKORIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:405 W MANCHESTER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1196
Mailing Address - Country:US
Mailing Address - Phone:310-672-3820
Mailing Address - Fax:310-672-3822
Practice Address - Street 1:405 W MANCHESTER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1196
Practice Address - Country:US
Practice Address - Phone:310-672-3820
Practice Address - Fax:310-672-3822
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)