Provider Demographics
NPI:1346640547
Name:BARRICK, KEELYN NOELLE (NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KEELYN
Middle Name:NOELLE
Last Name:BARRICK
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BARON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9442
Mailing Address - Country:US
Mailing Address - Phone:803-351-0114
Mailing Address - Fax:
Practice Address - Street 1:219 BARON RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9442
Practice Address - Country:US
Practice Address - Phone:803-351-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5929106H00000X
SC6387101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist