Provider Demographics
NPI:1932284072
Name:KEETON, WILLIAM PRESLEY III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PRESLEY
Last Name:KEETON
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22593 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-3054
Mailing Address - Country:US
Mailing Address - Phone:301-862-2505
Mailing Address - Fax:301-862-2548
Practice Address - Street 1:22593 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3054
Practice Address - Country:US
Practice Address - Phone:301-862-2505
Practice Address - Fax:301-862-2548
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05643103T00000X
NC1406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0426MOtherBLUE CROSS/BLUE SHIELD
NC6000345Medicaid
NC0426MOtherBLUE CROSS/BLUE SHIELD
NC518566Medicare UPIN