Provider Demographics
NPI:1992194658
Name:PERRY, KEISHA L (MSW, CAC II)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:L
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 COLONIAL DRIVE
Mailing Address - Street 2:LRADAC -
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-726-9427
Mailing Address - Fax:
Practice Address - Street 1:2711 COLONIAL DRIVE
Practice Address - Street 2:LRADAC -
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-726-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker