Individual
KEISHA LAKIA GAMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
895 BLUE HILL AVE, DORCHESTER, MA 02124-2902
(617) 506-8188
(617) 297-5039
Mailing address
133B LUCERNE ST, DORCHESTER, MA 02124-3923
(617) 593-1260
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
NONE
MA
01
—
0000
NONE
—
01
—
NONE
NONE
—
Enumeration date
03/22/2019
Last updated
03/22/2019
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