Provider Demographics
NPI:1740400415
Name:MCKEITHAN, IRINA ORLOVA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:ORLOVA
Last Name:MCKEITHAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:Y
Other - Last Name:ORLOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:158 E MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-8774
Mailing Address - Country:US
Mailing Address - Phone:918-607-4376
Mailing Address - Fax:
Practice Address - Street 1:182 W COURT ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2805
Practice Address - Country:US
Practice Address - Phone:828-287-7806
Practice Address - Fax:828-287-0004
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health