Provider Demographics
NPI:1447411343
Name:KEATON, KEINOSHA SHANTEZ
Entity Type:Individual
Prefix:
First Name:KEINOSHA
Middle Name:SHANTEZ
Last Name:KEATON
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 1:22 PLEASANT RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:214-601-6208
Mailing Address - Fax:
Practice Address - Street 1:22 PLEASANT RIDGE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2112
Practice Address - Country:US
Practice Address - Phone:214-601-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker