Provider Demographics
NPI:1790389633
Name:DIROSIER, KETURAH NASHIA (MHC, MFT)
Entity Type:Individual
Prefix:MRS
First Name:KETURAH
Middle Name:NASHIA
Last Name:DIROSIER
Suffix:
Gender:F
Credentials:MHC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 EAST ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2327
Mailing Address - Country:US
Mailing Address - Phone:305-807-7519
Mailing Address - Fax:
Practice Address - Street 1:5055 EAST ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2327
Practice Address - Country:US
Practice Address - Phone:305-807-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health