Healthcare Provider Details

I. General information

NPI: 1942670302
Provider Name (Legal Business Name): DESMOND KUDJI MSW, RSW, MHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 LOUIS PRIMA DR STE A
COVINGTON LA
70433-5903
US

IV. Provider business mailing address

60 LOUIS PRIMA DR STE A
COVINGTON LA
70433-5903
US

V. Phone/Fax

Practice location:
  • Phone: 985-327-5427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10996
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10996
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: