Provider Demographics
NPI:1497437008
Name:MCKEITHAN, ERIC BERNARD
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:BERNARD
Last Name:MCKEITHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 JAY ST NE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1850
Mailing Address - Country:US
Mailing Address - Phone:202-499-8180
Mailing Address - Fax:
Practice Address - Street 1:3217 ADAMS MILL RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1008
Practice Address - Country:US
Practice Address - Phone:202-644-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC4802007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor