Provider Demographics
NPI:1750804324
Name:ROBINSON, KEYAMBI LATANYA
Entity type:Individual
Prefix:
First Name:KEYAMBI
Middle Name:LATANYA
Last Name:ROBINSON
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 1:404 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:LA
Mailing Address - Zip Code:70079-2195
Mailing Address - Country:US
Mailing Address - Phone:504-231-1352
Mailing Address - Fax:
Practice Address - Street 1:118 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-6114
Practice Address - Country:US
Practice Address - Phone:985-206-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor