Healthcare Provider Details

I. General information

NPI: 1851059885
Provider Name (Legal Business Name): KEYANA GAUSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 CAPITAL BLVD
RALEIGH NC
27604-4478
US

IV. Provider business mailing address

10151 DONERAIL WAY APT 113
RALEIGH NC
27617-6231
US

V. Phone/Fax

Practice location:
  • Phone: 919-980-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP016769
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018773
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18201
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: