Provider Demographics
NPI:1578295804
Name:KEYSER, VIVIANNE NICOLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:NICOLE
Last Name:KEYSER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-9005
Mailing Address - Fax:
Practice Address - Street 1:2620 TRYON COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-7646
Practice Address - Country:US
Practice Address - Phone:704-836-9107
Practice Address - Fax:704-629-5967
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0177541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical