Provider Demographics
NPI:1043486061
Name:MOLDEN, KEISHA ANDREA
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:ANDREA
Last Name:MOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KEISHA
Other - Middle Name:ANNDREA
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:248 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3074
Mailing Address - Country:US
Mailing Address - Phone:650-363-4435
Mailing Address - Fax:650-361-1620
Practice Address - Street 1:248 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3074
Practice Address - Country:US
Practice Address - Phone:650-363-4435
Practice Address - Fax:650-361-1620
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X, 390200000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program