MEDICARE: KEYASIA C DOWNS LISW

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	104100000X	Social Worker	S.1903737	OH
2	1041C0700X	Clinical Social Worker	I.2203438	OH

General Provider Information

NPI Number	:	1053921361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYASIA C DOWNS LISW

Provider Business Mailing Address
First Line	:	9805 STATESVILLE RD # 6266
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7647
Country	:	US
Telephone Number	:	980-200-5978
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 MEADOW VILLAGE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4913
Country	:	US
Telephone Number	:	614-992-3525
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	06/02/2022

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Directions to “ KEYASIA C DOWNS LISW” Practice Location

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