Provider Demographics
NPI:1457300774
Name:NUNN, KEITH DAVID JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DAVID
Last Name:NUNN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1831
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1400 WILLOW LN
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3551
Practice Address - Country:US
Practice Address - Phone:336-667-5151
Practice Address - Fax:336-838-3133
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103158Medicaid
NC1413XOtherBLUECROSS BLUESHIELD OF N