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General NPI Number Information
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NPI Number | 1164158531
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Entity Type | Organization
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Legal Business Name | KECIA WEST LLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 1285 MARKS CHURCH RD STE F
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City | AUGUSTA
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State | GA
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Zip | 30909-2472
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Country | US
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Telephone | 404-769-8771
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Fax |
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Provider Business Mailing Address
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Address Line | 2566 SHALLOWFORD RD NE STE 104-118
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City | ATLANTA
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State | GA
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Zip | 30345-1249
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Country | US
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Telephone | 706-530-5397
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Fax | 706-609-5753
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Authorized Official
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Title or Position | CEO
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Name | KECIA WEST
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Credential | LPC
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Telephone | 706-530-5397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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