Healthcare Provider Details

I. General information

NPI: 1528094273
Provider Name (Legal Business Name): DEIDRA DICKEY KEENER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIDRA VICTORIA DICKEY LPC

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 VANN ROAD, SUITE A-6
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

3215 TRACE WAY
TRUSSVILLE AL
35173
US

V. Phone/Fax

Practice location:
  • Phone: 205-529-9894
  • Fax: 205-529-9894
Mailing address:
  • Phone: 205-706-7295
  • Fax: 205-510-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#2456
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: