Provider Demographics
NPI:1194061440
Name:NAKOA, ROCHELLE MK (LCSW)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:MK
Last Name:NAKOA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3105
Mailing Address - Country:US
Mailing Address - Phone:808-728-1162
Mailing Address - Fax:
Practice Address - Street 1:2200 SOMERVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3713
Practice Address - Country:US
Practice Address - Phone:410-990-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120138181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA 000Medicare UPIN