Provider Demographics
NPI:1851177067
Name:BORDEN, KEESHA L
Entity Type:Individual
Prefix:MS
First Name:KEESHA
Middle Name:L
Last Name:BORDEN
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 1:6903 ALDER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2663
Mailing Address - Country:US
Mailing Address - Phone:804-252-5211
Mailing Address - Fax:
Practice Address - Street 1:420 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4221
Practice Address - Country:US
Practice Address - Phone:804-252-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2024-01-26
Deactivation Date:2023-09-06
Deactivation Code:
Reactivation Date:2024-01-26
Provider Licenses
StateLicense IDTaxonomies
VA8049251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health