Healthcare Provider Details

I. General information

NPI: 1497204010
Provider Name (Legal Business Name): NEKEISHA MAXIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 CANAL ST
NEW ORLEANS LA
70119-6247
US

IV. Provider business mailing address

7200 BANCROFT AVE. BLDG. B SUITE 133
OAKLAND CA
94605
US

V. Phone/Fax

Practice location:
  • Phone: 504-644-2575
  • Fax:
Mailing address:
  • Phone: 510-553-8500
  • Fax: 510-553-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPLM1495
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: