Provider Demographics
NPI:1013075647
Name:KEATON, THEODORE ALVA III
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:ALVA
Last Name:KEATON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 BAKER DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2113
Mailing Address - Country:US
Mailing Address - Phone:925-827-1690
Mailing Address - Fax:925-827-1690
Practice Address - Street 1:3237 BAKER DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2113
Practice Address - Country:US
Practice Address - Phone:925-827-1690
Practice Address - Fax:925-827-1690
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker