Provider Demographics
NPI:1992471635
Name:MINUS, KEAYANA NICOLA
Entity type:Individual
Prefix:MRS
First Name:KEAYANA
Middle Name:NICOLA
Last Name:MINUS
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 1:107 ARAPAHO DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-5312
Mailing Address - Country:US
Mailing Address - Phone:478-997-2457
Mailing Address - Fax:
Practice Address - Street 1:370 E 160TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4404
Practice Address - Country:US
Practice Address - Phone:478-997-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health