MEDICARE: MRS. JOKENA C ISLAM MS, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1340	NC
2	106H00000X	Marriage & Family Therapist	4101006286	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477781664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOKENA C ISLAM MS, LMFT

Provider Business Mailing Address
First Line	:	204 MUIRS CHAPEL RD
Second Line	:	SUITE 105
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6173
Country	:	US
Telephone Number	:	336-609-6251
Fax Number	:	336-834-0442

Provider Business Practice Location Address
First Line	:	204 MUIRS CHAPEL RD
Second Line	:	SUITE 105
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6173
Country	:	US
Telephone Number	:	336-609-6251
Fax Number	:	336-834-0442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	12/31/2012

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