Provider Demographics
NPI:1255348108
Name:KEETON ENTERPRISES, INC.
Entity type:Organization
Organization Name:KEETON ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-356-1330
Mailing Address - Street 1:1810 ABBEY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1969
Mailing Address - Country:US
Mailing Address - Phone:793-356-1330
Mailing Address - Fax:703-938-1373
Practice Address - Street 1:407 CHURCH ST NE STE I
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4737
Practice Address - Country:US
Practice Address - Phone:703-356-1330
Practice Address - Fax:703-938-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty