Provider Demographics
NPI:1558565770
Name:KECK, SALLY ANN (MA, CCS, LADC, TTS-C)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:KECK
Suffix:
Gender:F
Credentials:MA, CCS, LADC, TTS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:COTTAGE PROGRAM
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-351-2430
Mailing Address - Fax:207-351-2189
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:COTTAGE PROGRAM
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-351-2430
Practice Address - Fax:207-351-2189
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME319402101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)