Healthcare Provider Details

I. General information

NPI: 1649056482
Provider Name (Legal Business Name): KATHERINE MARY AKIKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1395 ATWOOD AVE STE 106
JOHNSTON RI
02919-4930
US

IV. Provider business mailing address

112 MURRAY ST APT 6
PROVIDENCE RI
02909-5339
US

V. Phone/Fax

Practice location:
  • Phone: 401-241-3344
  • Fax:
Mailing address:
  • Phone: 617-877-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00122A
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: