Provider Demographics
NPI:1861680951
Name:LOUIS, KENYETTA V (LLMSW)
Entity Type:Individual
Prefix:
First Name:KENYETTA
Middle Name:V
Last Name:LOUIS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 MACKIN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1204
Mailing Address - Country:US
Mailing Address - Phone:810-257-3676
Mailing Address - Fax:810-257-0713
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1570
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:810-232-9110
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010881981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty