MEDICARE: KEYOSHIA C LIVERMAN

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	101YM0800X	Mental Health Counselor	0704015645	VA

General Provider Information

NPI Number	:	1396521993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYOSHIA C LIVERMAN

Provider Business Mailing Address
First Line	:	781 JONES WHITE RD
Second Line	:
City	:	ROPER
State	:	NC
Zip	:	27970-9665
Country	:	US
Telephone Number	:	252-505-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	6334 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4024
Country	:	US
Telephone Number	:	540-348-4700
Fax Number	:

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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Directions to “ KEYOSHIA C LIVERMAN ” Practice Location

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