Provider Demographics
NPI:1790139830
Name:RAWLES, KENIA MASHET (LMSW)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:MASHET
Last Name:RAWLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KENIA
Other - Middle Name:MASHET
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1447 US 19 S UNIT 19B
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5923
Mailing Address - Country:US
Mailing Address - Phone:229-518-8718
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006659104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker