Provider Demographics
NPI:1770765463
Name:COLLINS-GRIFFIN, KEESHA DEVONNE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KEESHA
Middle Name:DEVONNE
Last Name:COLLINS-GRIFFIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3162
Mailing Address - Country:US
Mailing Address - Phone:301-379-2934
Mailing Address - Fax:
Practice Address - Street 1:6490 LANDOVER RD STE D
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:301-379-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional