Individual
ALICE KEENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1037 PATHFINDER WAY, INTERVENTION SERVICES SUITE 130, ROCKLEDGE, FL 32955
(321) 639-1224
Mailing address
712 SARA JANE LN, MERRITT ISLAND, FL 32952-4944
(321) 208-5583
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7610
FL
101YP2500X
Professional Counselor
4821
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140EG
NVML BCBSNC GRP # 015HF
NC
05
—
6102594
—
NC
Enumeration date
08/30/2006
Last updated
10/19/2012
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