Provider Demographics
NPI:1396082210
Name:HOWARD, ANISSA KENYATTA (LPC, LMFT, RPT-S)
Entity type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:KENYATTA
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LPC, LMFT, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6934
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6934
Mailing Address - Country:US
Mailing Address - Phone:478-284-3554
Mailing Address - Fax:
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:478-238-3795
Practice Address - Fax:478-202-9018
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA856390101YS0200X
GALPC007142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool