Healthcare Provider Details

I. General information

NPI: 1184244360
Provider Name (Legal Business Name): KIJIJI ADVOCACY ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CAMBRIDGE CIR
CONROE TX
77304-2702
US

IV. Provider business mailing address

3400 KENT AVE APT M112
METAIRIE LA
70006-3998
US

V. Phone/Fax

Practice location:
  • Phone: 713-859-5872
  • Fax:
Mailing address:
  • Phone: 985-960-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. TERRI ALLEN
Title or Position: PROMOTIONS/MARKETING
Credential: DO
Phone: 936-500-2463