Individual
KRISTEN A KEENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC011189
GA
101YP2500X
Professional Counselor
Primary
LPC011189
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003229861A
—
GA
01
—
09637169
AMERIGROUP
GA
Enumeration date
10/21/2019
Last updated
01/22/2021
Update your record
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