Provider Demographics
NPI:1821125022
Name:KEENE, MARCIA L (LPC, LMFT, CRP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:L
Last Name:KEENE
Suffix:
Gender:F
Credentials:LPC, LMFT, CRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 OLD WATERFORD RD NW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2116
Mailing Address - Country:US
Mailing Address - Phone:703-727-2854
Mailing Address - Fax:
Practice Address - Street 1:209 OLD WATERFORD RD NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2116
Practice Address - Country:US
Practice Address - Phone:703-727-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002595101Y00000X
VA0717000577106H00000X
VA0715004083225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner