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General NPI Number Information
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NPI Number | 1457990285
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Entity Type | Individual
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Provider Name | KEISHA NICOLE WHITNEY QMHP C, QMHP A, CNA
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Gender | Female
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 201 WYNN ST
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3141
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Country | US
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Telephone | 757-621-0117
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Fax |
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Provider Business Mailing Address
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Address Line | 201 WYNN ST
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City | PORTSMOUTH
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State | VA
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Zip | 23701-3141
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Country | US
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Telephone | 757-621-0117
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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 | 0732003734
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 1401096837
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0733007314
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License Number State | VA
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