Provider Demographics
NPI:1992356505
Name:KEITH, TALEAH DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:TALEAH
Middle Name:DENISE
Last Name:KEITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TALEAH
Other - Middle Name:
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3010 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2719
Mailing Address - Country:US
Mailing Address - Phone:703-565-8792
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-6725
Practice Address - Fax:804-675-5655
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0214061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical