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Individual

GERIC LAKEITH KENEBREW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
71 W LAS FLORES DR, ALTADENA, CA 91001-4341
(626) 316-4740
Mailing address
71 W LAS FLORES DR, ALTADENA, CA 91001-4341
(626) 794-6797

Taxonomy

Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
26-2537-0-51918
TN
171M00000X
Case Manager/Care Coordinator
175T00000X
Peer Specialist
251B00000X
Case Management Agency

Other

Enumeration date
07/25/2024
Last updated
07/25/2024
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