Provider Demographics
NPI:1417683111
Name:KITOKO GOLDEN LIFE LLC
Entity Type:Organization
Organization Name:KITOKO GOLDEN LIFE LLC
Other - Org Name:GINAK COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MUJINGA
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:402-598-9522
Mailing Address - Street 1:3043 ARIZONA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3643
Mailing Address - Country:US
Mailing Address - Phone:402-598-9522
Mailing Address - Fax:
Practice Address - Street 1:7431 N 140TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-2168
Practice Address - Country:US
Practice Address - Phone:402-598-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5617Other1659930642