Provider Demographics
NPI:1164907788
Name:SPRINGS, KEISHA DENEE (MS, LCASA)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:DENEE
Last Name:SPRINGS
Suffix:
Gender:F
Credentials:MS, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 S MARTIN LUTHER KING JR DR STE 225
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1361
Mailing Address - Country:US
Mailing Address - Phone:336-464-3136
Mailing Address - Fax:
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR STE 225
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-464-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22249101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty