Provider Demographics
NPI:1154020816
Name:POUNDS, KEOSHA LASHAY
Entity type:Individual
Prefix:
First Name:KEOSHA
Middle Name:LASHAY
Last Name:POUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3119
Mailing Address - Country:US
Mailing Address - Phone:662-458-4742
Mailing Address - Fax:
Practice Address - Street 1:213 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3119
Practice Address - Country:US
Practice Address - Phone:662-458-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician