Provider Demographics
NPI:1063108645
Name:ANDERSON, LA KENYA JA'REE
Entity type:Individual
Prefix:
First Name:LA KENYA
Middle Name:JA'REE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LA KENYA
Other - Middle Name:JA'REE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6945 MERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3165
Mailing Address - Country:US
Mailing Address - Phone:678-448-6172
Mailing Address - Fax:
Practice Address - Street 1:225 HAMILTON E HOLMES DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7421
Practice Address - Country:US
Practice Address - Phone:404-802-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health