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General NPI Number Information
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NPI Number | 1801781331
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Entity Type | Organization
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Legal Business Name | THE KOKO BELLA PERMANENT MAKEUP AND LASH BAR
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 1911 BALTIMORE REYNOLDSBURG RD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-8105
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Country | US
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Telephone | 614-452-9821
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Fax |
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Provider Business Mailing Address
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Address Line | 257 KINGSMEADOW LN
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City | BLACKLICK
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State | OH
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Zip | 43004-9204
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Country | US
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Telephone | 330-371-6698
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PEER RECOVERY SUPPORTER
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Name | CARNEKA J GREEN
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Credential |
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Telephone | 330-371-6698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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