Provider Demographics
NPI:1275941775
Name:KHEMET GOUDJAYI, NEFERTITI K (LCSW)
Entity Type:Individual
Prefix:
First Name:NEFERTITI
Middle Name:K
Last Name:KHEMET GOUDJAYI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 GREENBACK LN # 149
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5653
Mailing Address - Country:US
Mailing Address - Phone:916-243-5337
Mailing Address - Fax:
Practice Address - Street 1:7405 GREENBACK LN # 149F
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5653
Practice Address - Country:US
Practice Address - Phone:916-243-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1028301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical