Provider Demographics
NPI:1558985648
Name:KEENUM, SHIMILA L
Entity Type:Individual
Prefix:
First Name:SHIMILA
Middle Name:L
Last Name:KEENUM
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 1:1285 MAJESTIC OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4450
Mailing Address - Country:US
Mailing Address - Phone:434-515-2555
Mailing Address - Fax:
Practice Address - Street 1:1285 MAJESTIC OAKS DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4450
Practice Address - Country:US
Practice Address - Phone:434-515-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health