Provider Demographics
NPI:1164573580
Name:KONIKOFF, CONSTANCE ANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANNE
Last Name:KONIKOFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 RIDGEWAY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3532
Mailing Address - Country:US
Mailing Address - Phone:337-258-6125
Mailing Address - Fax:
Practice Address - Street 1:143 RIDGEWAY DR STE 207
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3532
Practice Address - Country:US
Practice Address - Phone:337-258-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical