Provider Demographics
NPI:1164158531
Name:KECIA WEST LLC
Entity Type:Organization
Organization Name:KECIA WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-530-5397
Mailing Address - Street 1:2566 SHALLOWFORD RD NE STE 104-118
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1249
Mailing Address - Country:US
Mailing Address - Phone:706-530-5397
Mailing Address - Fax:706-609-5753
Practice Address - Street 1:1285 MARKS CHURCH RD STE F
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2472
Practice Address - Country:US
Practice Address - Phone:404-769-8771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty