Provider Demographics
NPI:1154145746
Name:KEELING, DEZZIRE
Entity type:Individual
Prefix:
First Name:DEZZIRE
Middle Name:
Last Name:KEELING
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 1:6420 MERCANTILE DR E APT 205
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7611
Mailing Address - Country:US
Mailing Address - Phone:706-304-9266
Mailing Address - Fax:
Practice Address - Street 1:5525 TWIN KNOLLS RD STE 323
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3207
Practice Address - Country:US
Practice Address - Phone:301-330-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health