Provider Demographics
NPI:1386728319
Name:ROSS, KESHIA DUNN (LPC, LSATP, CCS, NCC)
Entity type:Individual
Prefix:DR
First Name:KESHIA
Middle Name:DUNN
Last Name:ROSS
Suffix:
Gender:
Credentials:LPC, LSATP, CCS, 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 151
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-0151
Mailing Address - Country:US
Mailing Address - Phone:571-774-5083
Mailing Address - Fax:866-311-4280
Practice Address - Street 1:3600 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-6202
Practice Address - Country:US
Practice Address - Phone:571-774-5083
Practice Address - Fax:866-311-4280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC889101YA0400X
NC4537101YP2500X
VA0701005230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102623Medicaid
NC6102585Medicaid