Provider Demographics
NPI:1578840781
Name:MCADAM, KEITH RAYMOND (LCSW, LCAS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:RAYMOND
Last Name:MCADAM
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 ANDREWS STREET
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-682-5777
Mailing Address - Fax:919-687-6975
Practice Address - Street 1:411 ANDREWS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2993
Practice Address - Country:US
Practice Address - Phone:919-682-5777
Practice Address - Fax:919-687-6975
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1623101YA0400X
NCC0066741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical