Individual
JILLIAN KEENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-1000
Mailing address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1263
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30610026
—
KY
Enumeration date
08/03/2011
Last updated
02/09/2021
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