Individual
KEISHIA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
259 BILL FRANCE BLVD, SUIT 200, DAYTONA BEACH, FL 32114-1316
(386) 206-8071
Mailing address
86 WHEATFIELD DR, A, PALM COAST, FL 32164-3932
(904) 881-9803
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
IMH9259
FL
Other
Enumeration date
09/23/2015
Last updated
09/29/2015
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