Healthcare Provider Details

I. General information

NPI: 1265927172
Provider Name (Legal Business Name): KESENA JONES OLEITA OWNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23111 LEIGHWOOD DR
WOODHAVEN MI
48183-2772
US

IV. Provider business mailing address

23111 LEIGHWOOD DR
WOODHAVEN MI
48183-2772
US

V. Phone/Fax

Practice location:
  • Phone: 832-387-8068
  • Fax: 734-307-7719
Mailing address:
  • Phone: 832-387-8068
  • Fax: 734-307-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4151001104
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: