Provider Demographics
NPI:1366018798
Name:HYPOLITE, KEIASHA ANDERA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KEIASHA
Middle Name:ANDERA
Last Name:HYPOLITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61024
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-1024
Mailing Address - Country:US
Mailing Address - Phone:337-849-9232
Mailing Address - Fax:
Practice Address - Street 1:220 W WILLOW ST BLDG A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2837
Practice Address - Country:US
Practice Address - Phone:337-262-5616
Practice Address - Fax:337-262-1310
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA105971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical