Provider Demographics
NPI:1104343375
Name:KEENER, AYANNIA MOHAMMAD (BSW-LSW)
Entity type:Individual
Prefix:
First Name:AYANNIA
Middle Name:MOHAMMAD
Last Name:KEENER
Suffix:
Gender:F
Credentials:BSW-LSW
Other - Prefix:
Other - First Name:AYANNIA
Other - Middle Name:MOHAMMAD
Other - Last Name:AL-MAHMOUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW-LSW
Mailing Address - Street 1:372 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6104
Mailing Address - Country:US
Mailing Address - Phone:614-312-2926
Mailing Address - Fax:
Practice Address - Street 1:1455 S 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1011
Practice Address - Country:US
Practice Address - Phone:614-732-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0281533Medicaid