Healthcare Provider Details

I. General information

NPI: 1457991952
Provider Name (Legal Business Name): AMEENA KEMAVOR LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 BANNOCKBURN BLVD
BLACKLICK OH
43004-9786
US

IV. Provider business mailing address

1900 BRICE RD STE B
REYNOLDSBURG OH
43068-3403
US

V. Phone/Fax

Practice location:
  • Phone: 614-849-2389
  • Fax:
Mailing address:
  • Phone: 614-239-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0500614
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0500614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: