Provider Demographics
NPI:1427190099
Name:KEENER-MIKENAS, LUANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LUANN
Middle Name:
Last Name:KEENER-MIKENAS
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 1:311 RIVERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2336
Mailing Address - Country:US
Mailing Address - Phone:434-221-0778
Mailing Address - Fax:858-769-0273
Practice Address - Street 1:311 RIVERMONT AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2336
Practice Address - Country:US
Practice Address - Phone:434-221-0778
Practice Address - Fax:858-769-0273
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA885734970OtherNASW
VA0904004495OtherLCSW LICENSE #
VA11526517OtherCAQH