Provider Demographics
NPI:1528094273
Name:KEENER, DEIDRA DICKEY (LPC)
Entity type:Individual
Prefix:MS
First Name:DEIDRA
Middle Name:DICKEY
Last Name:KEENER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:DEIDRA
Other - Middle Name:VICTORIA
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3215 TRACE WAY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-706-7295
Mailing Address - Fax:205-510-2790
Practice Address - Street 1:3536 VANN ROAD, SUITE A-6
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-529-9894
Practice Address - Fax:205-529-9894
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL#2456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2456OtherLPC
AL51535583OtherBCBS FEDERAL EMPLOYEE
AL51535383OtherBLUE CROSS OF AL
AL330000034Medicaid
AL630288854OtherBEHAVIORAL HEALTH SVCS.
AL630288854OtherAMERICAN BEHAVIORAL HEALT