Provider Demographics
NPI:1043510548
Name:FERNANDEZ, KIANCA N (LPC-S)
Entity Type:Individual
Prefix:
First Name:KIANCA
Middle Name:N
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 GAUSE BLVD E STE 150
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5451
Mailing Address - Country:US
Mailing Address - Phone:985-649-1001
Mailing Address - Fax:985-644-1005
Practice Address - Street 1:2053 GAUSE BLVD E
Practice Address - Street 2:150
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5449
Practice Address - Country:US
Practice Address - Phone:985-649-1001
Practice Address - Fax:985-646-1005
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional