Provider Demographics
NPI:1801496633
Name:MACK, KEESHA C (LCPC)
Entity type:Individual
Prefix:
First Name:KEESHA
Middle Name:C
Last Name:MACK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KEESHA
Other - Middle Name:C
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 FELICIA CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2539
Mailing Address - Country:US
Mailing Address - Phone:215-287-0494
Mailing Address - Fax:
Practice Address - Street 1:1212 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3416
Practice Address - Country:US
Practice Address - Phone:215-287-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health