Provider Demographics
NPI:1902310378
Name:KEEN, ANACELIA (LICSW, SUDPT)
Entity Type:Individual
Prefix:
First Name:ANACELIA
Middle Name:
Last Name:KEEN
Suffix:
Gender:F
Credentials:LICSW, SUDPT
Other - Prefix:
Other - First Name:ANACELIA
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6317 199TH WAY SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579
Mailing Address - Country:US
Mailing Address - Phone:360-515-6084
Mailing Address - Fax:
Practice Address - Street 1:2428 W REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4554
Practice Address - Country:US
Practice Address - Phone:360-330-9044
Practice Address - Fax:360-736-3139
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60791186101YM0800X
WALW60993037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health