Provider Demographics
NPI:1952045072
Name:KEETON, PAULA MAE (PHD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MAE
Last Name:KEETON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 TURTLE CROSS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-9329
Mailing Address - Country:US
Mailing Address - Phone:319-331-5331
Mailing Address - Fax:
Practice Address - Street 1:3401 TURTLE CROSS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-9329
Practice Address - Country:US
Practice Address - Phone:319-331-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5688103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling