Provider Demographics
NPI:1336756626
Name:DRAKE, KEZIA EILEEN (LPC)
Entity Type:Individual
Prefix:
First Name:KEZIA
Middle Name:EILEEN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3012
Mailing Address - Country:US
Mailing Address - Phone:903-872-4442
Mailing Address - Fax:903-872-2125
Practice Address - Street 1:715 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3012
Practice Address - Country:US
Practice Address - Phone:903-872-4442
Practice Address - Fax:903-872-2125
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional