Provider Demographics
NPI:1477781664
Name:ISLAM, JOKENA C (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JOKENA
Middle Name:C
Last Name:ISLAM
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MUIRS CHAPEL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6173
Mailing Address - Country:US
Mailing Address - Phone:336-609-6251
Mailing Address - Fax:336-834-0442
Practice Address - Street 1:204 MUIRS CHAPEL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6173
Practice Address - Country:US
Practice Address - Phone:336-609-6251
Practice Address - Fax:336-834-0442
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1340106H00000X
MI4101006286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI213119549Medicaid
NC6105279Medicaid