Organization
KINGDOM EXPRESSIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAKERA L MCKENZIE (CEO)
(337) 602-6391
Entity
Organization
Contact information
Practice address
1639 RYAN ST STE B, LAKE CHARLES, LA 70601-5948
(888) 859-4202
Mailing address
1634 RYAN ST, LAKE CHARLES, LA 70601-5949
(376) 026-3913
(337) 602-6392
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
12/29/2016
Last updated
06/21/2023
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