Provider Demographics
NPI:1508643644
Name:WILLIAMS, KENITA
Entity Type:Individual
Prefix:
First Name:KENITA
Middle Name:
Last Name:WILLIAMS
Suffix:
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 1:1900 MOUNT HOLLY RD STE 6D
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4727
Mailing Address - Country:US
Mailing Address - Phone:609-614-7495
Mailing Address - Fax:
Practice Address - Street 1:1900 MOUNT HOLLY RD STE 6D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4727
Practice Address - Country:US
Practice Address - Phone:609-614-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-292816106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician