Provider Demographics
NPI:1609063189
Name:KEITH, MARCIE LOU
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:LOU
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 MERIWETHER DR APT I
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2880
Mailing Address - Country:US
Mailing Address - Phone:919-220-5680
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE DR STE 401
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8548
Practice Address - Country:US
Practice Address - Phone:919-643-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health