MEDICARE: KEISHA M HEARD LCAS-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	24152	NC

General Provider Information

NPI Number	:	1033783261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA M HEARD LCAS-A

Provider Business Mailing Address
First Line	:	7 DUNDAS CIR STE L
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1645
Country	:	US
Telephone Number	:	828-655-2931
Fax Number	:	336-450-1549

Provider Business Practice Location Address
First Line	:	7 DUNDAS CIR STE L
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1645
Country	:	US
Telephone Number	:	828-655-2931
Fax Number	:	336-450-1549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	01/08/2026

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