Individual
ANEESAH MAILAKIA BANKHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TCADC
Contact information
Practice address
1450 MADISON AVE, COVINGTON, KY 41011-3369
(859) 444-4499
Mailing address
1450 MADISON AVE, COVINGTON, KY 41011-3369
(859) 444-4499
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
170644
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2405
—
OH
Enumeration date
04/08/2019
Last updated
04/08/2019
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