Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KEYONNA WALLACE
Active Sole ProprietorKEYONNA WALLACE is a Addiction (Substance Use Disorder) Counselor healthcare provider located in KEW GARDENS, New York. NPI 1861032864 is currently active in the NPPES registry. Verify at CMS.
Addiction (Substance Use Disorder) Counselor · KEW GARDENS, NY
Registration Details
- NPI Number
- 1861032864
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jan 8, 2020 (6.4129251347791 yrs)
- Last Updated
- Oct 19, 2020
- License
-
31387 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
8002 KEW GARDENS RD STE 704KEW GARDENS, NY, 114153607Browse NY providers · Browse ZIP 11415
- Phone
- 7185201513
- Primary Specialty
-
Addiction (Substance Use Disorder) Counselor
101YA0400X
Other Addiction (Substance Use Disorder) Counselor Providers in KEW GARDENS, NY
| Name | Credential | NPI |
|---|---|---|
| MONICA PERRY | CASAC 2 | 1124283940 |
| LILLIAN S MEDINA | CASAC-T | 1821253642 |
| ELLEN FLORENCE POWELL | CASAC | 1659537702 |
| ANDREA BAST | RN | 1891031217 |
| DAVID WASHINGTON | LMSW | 1780021212 |
| MIOSOTIS RAMIREZ | CIT | 1568896645 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.