Provider Demographics
NPI:1649056482
Name:AKIKIE, KATHERINE MARY
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:AKIKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MURRAY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5339
Mailing Address - Country:US
Mailing Address - Phone:617-877-1695
Mailing Address - Fax:
Practice Address - Street 1:1395 ATWOOD AVE STE 106
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4930
Practice Address - Country:US
Practice Address - Phone:401-241-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00122A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health