Provider Demographics
NPI:1689497109
Name:SADIKI, KENYATTA (LCDC, CART)
Entity type:Individual
Prefix:
First Name:KENYATTA
Middle Name:
Last Name:SADIKI
Suffix:
Gender:M
Credentials:LCDC, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 SOUTHWEST FWY STE 1136
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2066
Mailing Address - Country:US
Mailing Address - Phone:713-679-0219
Mailing Address - Fax:
Practice Address - Street 1:7322 SOUTHWEST FWY STE 1136
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2066
Practice Address - Country:US
Practice Address - Phone:713-679-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 101Y00000X
TX14393101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor