Healthcare Provider Details

I. General information

NPI: 1013564061
Provider Name (Legal Business Name): MS. GIANNOULA KEFALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLAT 1 13 PIERREPOINT ROAD
LONDON EALING
W3 9JJ
GB

IV. Provider business mailing address

FLAT 1 13 PIERREPOINT ROAD
LONDON EALING
W3 9JJ
GB

V. Phone/Fax

Practice location:
  • Phone: 778-379-4919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: