Individual
KEWANNA KEION COCKERHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
733 DANTE ST, NEW ORLEANS, LA 70118-1013
(504) 517-1711
Mailing address
5 MARCUS CHRISTIAN CIR, NEW ORLEANS, LA 70126-5657
(504) 405-0972
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7770000644136203
—
LA
Enumeration date
01/11/2020
Last updated
01/14/2020
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