Provider Demographics
NPI:1760840862
Name:PETERS, KEYANNA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KEYANNA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LEIGHTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3805
Mailing Address - Country:US
Mailing Address - Phone:256-343-4080
Mailing Address - Fax:256-937-7063
Practice Address - Street 1:1525 LEIGHTON AVE STE B
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-343-4080
Practice Address - Fax:256-937-7063
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional