Provider Demographics
NPI:1316799752
Name:RAINES, KIOLA (MS, CPSS)
Entity type:Individual
Prefix:MISS
First Name:KIOLA
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:MS, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3129
Mailing Address - Country:US
Mailing Address - Phone:323-889-9807
Mailing Address - Fax:
Practice Address - Street 1:1261 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3129
Practice Address - Country:US
Practice Address - Phone:323-889-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-JTVNFL175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist