Provider Demographics
NPI:1902145204
Name:KEENA, VIRGINIA (MA, LLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:KEENA
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20960 KELLY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3137
Mailing Address - Country:US
Mailing Address - Phone:586-585-1955
Mailing Address - Fax:586-585-1963
Practice Address - Street 1:20960 KELLY RD
Practice Address - Street 2:SUITE B
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3137
Practice Address - Country:US
Practice Address - Phone:586-585-1955
Practice Address - Fax:586-585-1963
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010086131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical