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Individual

MS. SHIRLEY KETAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, CDC1

Contact information

Practice address
121 W FIREWEED LN, ANCHORAGE, AK 99503-2053
(907) 865-9653
Mailing address
11408 HERITAGE CT APT 7, EAGLE RIVER, AK 99577-7778
(907) 854-6997

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
NH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4099
AK

Other

Enumeration date
01/31/2018
Last updated
01/31/2018
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