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General NPI Number Information
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NPI Number | 1851059885
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Entity Type | Individual
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Provider Name | KEYANA GAUSE LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4600 CAPITAL BLVD
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City | RALEIGH
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State | NC
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Zip | 27604-4478
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Country | US
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Telephone | 919-980-7008
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Fax |
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Provider Business Mailing Address
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Address Line | 10151 DONERAIL WAY APT 113
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City | RALEIGH
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State | NC
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Zip | 27617-6231
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | P016769
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C018773
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18201
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License Number State | SC
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