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General NPI Number Information
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NPI Number | 1316056674
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Entity Type | Individual
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Provider Name | ALICE KEENE LPC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 1037 PATHFINDER WAY INTERVENTION SERVICES SUITE 130
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-639-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 712 SARA JANE LN
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4944
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Country | US
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Telephone | 321-208-5583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7610
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4821
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License Number State | NC
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