Healthcare Provider Details

I. General information

NPI: 1184201030
Provider Name (Legal Business Name): KESHIA M EASTERLING PHD, LPC, CEAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 WILLIAMSPORT PL STE 390
ASHBURN VA
20147-6523
US

IV. Provider business mailing address

20755 WILLIAMSPORT PL STE 390
ASHBURN VA
20147-6523
US

V. Phone/Fax

Practice location:
  • Phone: 571-832-5077
  • Fax: 571-832-5078
Mailing address:
  • Phone: 571-832-5077
  • Fax: 571-832-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.002690
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5089-R
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010318
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC1052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: