Provider Demographics
NPI:1225662851
Name:ZOKER, KENNIE (RMHCI IMH25405)
Entity Type:Individual
Prefix:MR
First Name:KENNIE
Middle Name:
Last Name:ZOKER
Suffix:
Gender:M
Credentials:RMHCI IMH25405
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 PANTHER LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-1084
Mailing Address - Country:US
Mailing Address - Phone:904-993-2042
Mailing Address - Fax:
Practice Address - Street 1:1559 PANTHER LAKE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-1084
Practice Address - Country:US
Practice Address - Phone:904-993-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health