Provider Demographics
NPI:1871218016
Name:ANDREWS, KENIKO L'SHAY
Entity type:Individual
Prefix:
First Name:KENIKO
Middle Name:L'SHAY
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
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 1350
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-1350
Mailing Address - Country:US
Mailing Address - Phone:252-813-7887
Mailing Address - Fax:
Practice Address - Street 1:2506 NASH ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1393
Practice Address - Country:US
Practice Address - Phone:252-371-1589
Practice Address - Fax:252-371-1590
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0171611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty