Provider Demographics
NPI:1992699383
Name:DENNIS, KEISHA LAVON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:LAVON
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 JACOBS GROVE CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-8863
Mailing Address - Country:US
Mailing Address - Phone:254-226-4223
Mailing Address - Fax:
Practice Address - Street 1:7000 JACOBS GROVE CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-8863
Practice Address - Country:US
Practice Address - Phone:254-226-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040185221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical