Provider Demographics
NPI:1457603243
Name:HARRYHILL, KEITH D ((MPA, BSW, CAP))
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:HARRYHILL
Suffix:
Gender:M
Credentials:(MPA, BSW, CAP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2240
Mailing Address - Country:US
Mailing Address - Phone:386-310-8766
Mailing Address - Fax:386-760-4142
Practice Address - Street 1:2089 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2240
Practice Address - Country:US
Practice Address - Phone:386-310-8766
Practice Address - Fax:386-760-4142
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)