Provider Demographics
NPI:1760901953
Name:KELLER, CHRISTINE ALICIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ALICIA
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:ALICIA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 WISE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5521
Mailing Address - Country:US
Mailing Address - Phone:843-365-8884
Mailing Address - Fax:
Practice Address - Street 1:2404 WISE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5521
Practice Address - Country:US
Practice Address - Phone:843-365-8884
Practice Address - Fax:843-365-6685
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)