Provider Demographics
NPI:1376032425
Name:KEITH, NEKEISHA
Entity Type:Individual
Prefix:
First Name:NEKEISHA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NEKEISHA
Other - Middle Name:
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NEKEISHA KEITH, LPC
Mailing Address - Street 1:PO BOX 7521
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7521
Mailing Address - Country:US
Mailing Address - Phone:843-790-8018
Mailing Address - Fax:
Practice Address - Street 1:700 S PARKER DR STE 5
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6059
Practice Address - Country:US
Practice Address - Phone:843-790-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8910101YM0800X, 101YS0200X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool