Provider Demographics
NPI:1710421979
Name:BROWN, KEIANA (LCSW)
Entity type:Individual
Prefix:
First Name:KEIANA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-0485
Mailing Address - Country:US
Mailing Address - Phone:904-383-8901
Mailing Address - Fax:
Practice Address - Street 1:8152 VAL DEL RD
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-6468
Practice Address - Country:US
Practice Address - Phone:904-415-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002119104100000X
GACSW009813171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171W00000XOther Service ProvidersContractor