Provider Demographics
NPI:1609148980
Name:CHENEY, KEITH WARREN (LMFT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:WARREN
Last Name:CHENEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OVERHILL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8232
Mailing Address - Country:US
Mailing Address - Phone:704-287-0338
Mailing Address - Fax:704-799-8949
Practice Address - Street 1:125 OVERHILL DR STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8232
Practice Address - Country:US
Practice Address - Phone:704-287-0338
Practice Address - Fax:704-799-8949
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist