Provider Demographics
NPI:1467638833
Name:KEMAKOLAM, BRETHA NWAMAKA (N/A)
Entity type:Individual
Prefix:MRS
First Name:BRETHA
Middle Name:NWAMAKA
Last Name:KEMAKOLAM
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:2122 REDCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5023
Mailing Address - Country:US
Mailing Address - Phone:832-878-2895
Mailing Address - Fax:281-261-1273
Practice Address - Street 1:2122 REDCLIFF DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5023
Practice Address - Country:US
Practice Address - Phone:832-878-2895
Practice Address - Fax:281-261-1273
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health