Provider Demographics
NPI:1437457652
Name:THOMAS, KEISHA LYNN (BA, BCABA, LABA)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BA, BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2435
Mailing Address - Country:US
Mailing Address - Phone:863-837-8007
Mailing Address - Fax:
Practice Address - Street 1:2041 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2435
Practice Address - Country:US
Practice Address - Phone:863-837-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
VA0134000156103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist