Provider Demographics
NPI:1457991952
Name:KEMAVOR, AMEENA (LPCC-S)
Entity type:Individual
Prefix:DR
First Name:AMEENA
Middle Name:
Last Name:KEMAVOR
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BRICE RD STE B
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3403
Mailing Address - Country:US
Mailing Address - Phone:614-239-9965
Mailing Address - Fax:
Practice Address - Street 1:168 BANNOCKBURN BLVD
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9786
Practice Address - Country:US
Practice Address - Phone:614-849-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500614101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional