Provider Demographics
NPI:1336445196
Name:AIKENS, MOMILANA FELICIA (IMF)
Entity Type:Individual
Prefix:
First Name:MOMILANA
Middle Name:FELICIA
Last Name:AIKENS
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:MOMILANA
Other - Middle Name:
Other - Last Name:CAMBRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-4337
Mailing Address - Country:US
Mailing Address - Phone:619-253-3494
Mailing Address - Fax:
Practice Address - Street 1:1701 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-4337
Practice Address - Country:US
Practice Address - Phone:619-253-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91040106H00000X
CA66242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist