Provider Demographics
NPI:1871744326
Name:CHENEVERT, NAKISIA MONIQUE (CM)
Entity type:Individual
Prefix:
First Name:NAKISIA
Middle Name:MONIQUE
Last Name:CHENEVERT
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-5508
Mailing Address - Country:US
Mailing Address - Phone:405-812-0642
Mailing Address - Fax:405-812-0642
Practice Address - Street 1:5505 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5508
Practice Address - Country:US
Practice Address - Phone:405-812-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OK4742101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health