Provider Demographics
NPI:1346594637
Name:KEITH, NANCY G (MS, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:KEITH
Suffix:
Gender:F
Credentials:MS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LYNNDALE CT STE F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5443
Mailing Address - Country:US
Mailing Address - Phone:252-353-8001
Mailing Address - Fax:
Practice Address - Street 1:2303 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3749
Practice Address - Country:US
Practice Address - Phone:252-744-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0064441041C0700X
NCC0082941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical