Provider Demographics
NPI:1871037481
Name:ANUKAM, CHELSEA AJUKA (LAC)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:AJUKA
Last Name:ANUKAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8701
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0701
Mailing Address - Country:US
Mailing Address - Phone:316-550-1887
Mailing Address - Fax:
Practice Address - Street 1:801 E DOUGLAS AVE FL 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3548
Practice Address - Country:US
Practice Address - Phone:316-550-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLAC203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)