Provider Demographics
NPI:1407376502
Name:EMEZIE, KENNIE ADAOBI X
Entity Type:Individual
Prefix:
First Name:KENNIE
Middle Name:ADAOBI
Last Name:EMEZIE
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 GENTILLY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3808
Mailing Address - Country:US
Mailing Address - Phone:504-948-6080
Mailing Address - Fax:504-948-6089
Practice Address - Street 1:3028 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-948-6080
Practice Address - Fax:504-948-6089
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid