Provider Demographics
NPI:1396053823
Name:HORTON, KEITH WILSON (MA,LPC,LISW-CP)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WILSON
Last Name:HORTON
Suffix:
Gender:M
Credentials:MA,LPC,LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 RIBAUT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5425
Mailing Address - Country:US
Mailing Address - Phone:843-524-5437
Mailing Address - Fax:843-524-0425
Practice Address - Street 1:964 RIBAUT RD STE 1
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5425
Practice Address - Country:US
Practice Address - Phone:843-524-5437
Practice Address - Fax:843-524-0425
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical