Individual
KEISHA NICOLE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRSS
Contact information
Practice address
101 LOGAN ST STE 200, WILLIAMSON, WV 25661-0016
(304) 235-3570
Mailing address
141 COW CREEK RD, OMAR, WV 25638-9516
(304) 928-5656
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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