Healthcare Provider Details

I. General information

NPI: 1902488083
Provider Name (Legal Business Name): KEZIA DRAKE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MARIGOLD LN
WAXAHACHIE TX
75165-2659
US

IV. Provider business mailing address

120 MARIGOLD LN
WAXAHACHIE TX
75165-2659
US

V. Phone/Fax

Practice location:
  • Phone: 903-872-4442
  • Fax:
Mailing address:
  • Phone: 903-872-4442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEZIA DRAKE
Title or Position: LPC
Credential: LPC
Phone: 903-872-4442