Healthcare Provider Details

I. General information

NPI: 1528905601
Provider Name (Legal Business Name): KIESHA MARIE CONNER CIT, MSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DOTY RD
FERRIDAY LA
71334-4053
US

IV. Provider business mailing address

712 TEXAS AVE
FERRIDAY LA
71334-2742
US

V. Phone/Fax

Practice location:
  • Phone: 318-437-7040
  • Fax: 318-437-7041
Mailing address:
  • Phone: 318-437-7040
  • Fax: 318-437-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCIT-6131
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: