Provider Demographics
NPI:1124581392
Name:KEATON COMMUNITY SERVICES PLLC
Entity Type:Organization
Organization Name:KEATON COMMUNITY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KEATON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-508-0714
Mailing Address - Street 1:6715 HOCKETT COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-8262
Mailing Address - Country:US
Mailing Address - Phone:336-508-0714
Mailing Address - Fax:336-217-8847
Practice Address - Street 1:6715 HOCKETT COUNTRY LN
Practice Address - Street 2:
Practice Address - City:PLEASANT GARDEN
Practice Address - State:NC
Practice Address - Zip Code:27313-8262
Practice Address - Country:US
Practice Address - Phone:336-508-0714
Practice Address - Fax:336-217-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty