Provider Demographics
NPI:1699373589
Name:MILBOURNE, KENYA LA-SHAWN (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:KENYA
Middle Name:LA-SHAWN
Last Name:MILBOURNE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GATEWATER CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7541
Mailing Address - Country:US
Mailing Address - Phone:919-218-0880
Mailing Address - Fax:
Practice Address - Street 1:105 GATEWATER CT
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7541
Practice Address - Country:US
Practice Address - Phone:919-218-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0149341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP014934OtherASSOCIATE LICENSE