Provider Demographics
NPI:1114562758
Name:FURROW, KECIA LEA (HIS)
Entity Type:Individual
Prefix:MRS
First Name:KECIA
Middle Name:LEA
Last Name:FURROW
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8052 CARROLLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6087
Mailing Address - Country:US
Mailing Address - Phone:276-236-0778
Mailing Address - Fax:276-236-8600
Practice Address - Street 1:8052 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6087
Practice Address - Country:US
Practice Address - Phone:276-236-0778
Practice Address - Fax:276-236-8600
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002313237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist