Provider Demographics
NPI:1134914740
Name:BARRETT, KEISHONNA NICOLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KEISHONNA
Middle Name:NICOLE
Last Name:BARRETT
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KEISHONNA
Other - Middle Name:NICOLE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5400 BORDEAUX WAY APT 101-6
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4672
Mailing Address - Country:US
Mailing Address - Phone:804-873-9527
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040182621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical