Provider Demographics
NPI:1336834514
Name:FLEURISSAINT, KEEANA MONIQUE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KEEANA
Middle Name:MONIQUE
Last Name:FLEURISSAINT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD STE 222
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3616
Mailing Address - Country:US
Mailing Address - Phone:248-865-9418
Mailing Address - Fax:
Practice Address - Street 1:7125 ORCHARD LAKE RD STE 222
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3616
Practice Address - Country:US
Practice Address - Phone:248-865-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090150104100000X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker