Individual
ANDREA LYNETTE KEEN-AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
184 SONATA CIR, POOLER, GA 31322-4936
(443) 986-6031
Mailing address
184 SONATA CIR, POOLER, GA 31322-4936
(443) 986-6031
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004668
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW004668
STATE LICENSE
GA
Enumeration date
03/25/2020
Last updated
03/25/2020
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