Provider Demographics
NPI:1225592140
Name:KEA, INDIA ALEXIS
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:ALEXIS
Last Name:KEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7546 WILHELM DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3752
Mailing Address - Country:US
Mailing Address - Phone:301-467-6368
Mailing Address - Fax:
Practice Address - Street 1:9015 WOODYARD RD STE 210
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4209
Practice Address - Country:US
Practice Address - Phone:301-899-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health