Provider Demographics
NPI:1023592243
Name:RATES WHITE, KEYONI (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:KEYONI
Middle Name:
Last Name:RATES WHITE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MRS
Other - First Name:KEYONI
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:1215 W 10TH ST APT 817
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1283
Mailing Address - Country:US
Mailing Address - Phone:216-512-1490
Mailing Address - Fax:
Practice Address - Street 1:11401 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5476
Practice Address - Country:US
Practice Address - Phone:216-416-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102328-SUPV101YP2500X
OHE.2102328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional