Provider Demographics
NPI:1043403637
Name:COTTLE, KEITH BRYAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:BRYAN
Last Name:COTTLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 WESTWOOD AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4315
Mailing Address - Country:US
Mailing Address - Phone:336-878-6042
Mailing Address - Fax:336-878-6122
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4315
Practice Address - Country:US
Practice Address - Phone:336-878-6042
Practice Address - Fax:336-878-6122
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional