Provider Demographics
NPI:1447575717
Name:O'KEEFE, ADELE LOGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ADELE
Middle Name:LOGAN
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:PHD
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004782101YP2500X
VA0717001214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-086OtherTRICARE/CHAMPUS
VAPAROtherAETNA BEHAVIORAL HEALTH
VAPAROtherUNITED BEHAVIORAL HEALTH
VA1447575717Medicaid
VAPAROtherCORVEL
VAPAROtherUSA MANAGED CARE
VAPAROtherMANAGED HEALTH NETWORK
VA1447575717OtherOPTIMA BEHAVIORAL HEALTH
VAPAROtherCIGNA BEHAVIORAL HEALTH
VA1447575717OtherFIRST HEALTH COMMERCIAL
VAPAROtherVIRGINIA HEALTH NETWORK
VA1447575715OtherVIRGINIA PREMIER HEALTH PLAN
VA454466OtherANTHEM BEHAVIORAL HEALTH
VAPAROtherMULTIPLAN
VAPAROtherMAGELLAN HEALTH SERVICES