Healthcare Provider Details

I. General information

NPI: 1114483179
Provider Name (Legal Business Name): KEENER COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 VANN RD STE A6
BIRMINGHAM AL
35235-3208
US

IV. Provider business mailing address

3215 TRACE WAY
TRUSSVILLE AL
35173-2334
US

V. Phone/Fax

Practice location:
  • Phone: 205-529-9894
  • Fax: 205-900-8793
Mailing address:
  • Phone: 205-706-7295
  • Fax: 205-900-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEIDRA DICKEY KEENER
Title or Position: OWNER
Credential: LPC
Phone: 205-706-7295