Provider Demographics
NPI:1194064212
Name:BODINE, KEENA D (MED, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KEENA
Middle Name:D
Last Name:BODINE
Suffix:
Gender:F
Credentials:MED, LPC, NCC
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 157
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30639-0157
Mailing Address - Country:US
Mailing Address - Phone:706-246-0733
Mailing Address - Fax:706-246-0722
Practice Address - Street 1:63 SPRINGS STATION DR.
Practice Address - Street 2:
Practice Address - City:FRANKLIN SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30639
Practice Address - Country:US
Practice Address - Phone:706-246-0733
Practice Address - Fax:706-246-0722
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional