Provider Demographics
NPI:1720764848
Name:PATTON, KEISHA KWAN (LPC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:KWAN
Last Name:PATTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KWAN
Other - Middle Name:
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:680 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2113
Mailing Address - Country:US
Mailing Address - Phone:475-359-3899
Mailing Address - Fax:
Practice Address - Street 1:33 HOLCOMB AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-2423
Practice Address - Country:US
Practice Address - Phone:475-359-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional