Provider Demographics
NPI:1689254740
Name:KEETER, CONNOR LANGSTON (LCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:CONNOR
Middle Name:LANGSTON
Last Name:KEETER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:MS
Other - First Name:CONNOR
Other - Middle Name:ELLYN
Other - Last Name:LANGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1427 MILITARY CUTOFF RD STE 211
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3696
Mailing Address - Country:US
Mailing Address - Phone:336-675-8287
Mailing Address - Fax:910-338-0129
Practice Address - Street 1:1427 MILITARY CUTOFF RD STE 211
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3696
Practice Address - Country:US
Practice Address - Phone:336-675-8287
Practice Address - Fax:910-338-0129
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health