Provider Demographics
NPI:1043718547
Name:KEYS, MICHELLE MARIE (MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:KEYS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 DRYWALL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6341
Mailing Address - Country:US
Mailing Address - Phone:717-649-9138
Mailing Address - Fax:843-712-8660
Practice Address - Street 1:3015 DRYWALL DR STE 101
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6341
Practice Address - Country:US
Practice Address - Phone:717-649-9138
Practice Address - Fax:843-812-8660
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009561101YM0800X
SC7834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health