Provider Demographics
NPI:1841421302
Name:LORETTA KEELIN COUNSELING, INC
Entity Type:Organization
Organization Name:LORETTA KEELIN COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KEELIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-938-9338
Mailing Address - Street 1:824 GUM BRANCH RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6272
Mailing Address - Country:US
Mailing Address - Phone:910-938-9338
Mailing Address - Fax:910-989-0377
Practice Address - Street 1:824 GUM BRANCH RD
Practice Address - Street 2:SUITE O
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6272
Practice Address - Country:US
Practice Address - Phone:910-938-9338
Practice Address - Fax:910-989-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-01
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0030271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty