Provider Demographics
NPI:1386237543
Name:KESI THERAPY AND HOLISTIC ARTS
Entity type:Organization
Organization Name:KESI THERAPY AND HOLISTIC ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAPRINCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-449-5545
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:LIZELLA
Mailing Address - State:GA
Mailing Address - Zip Code:31052-0964
Mailing Address - Country:US
Mailing Address - Phone:478-449-5545
Mailing Address - Fax:478-935-9213
Practice Address - Street 1:507 N DAVIS DR STE 1A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2687
Practice Address - Country:US
Practice Address - Phone:478-449-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)