Provider Demographics
NPI:1518025956
Name:POCHE, KEITH (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:POCHE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 JACKSON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2600
Mailing Address - Country:US
Mailing Address - Phone:919-200-5217
Mailing Address - Fax:252-650-2214
Practice Address - Street 1:608 JACKSON ST STE 212
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2600
Practice Address - Country:US
Practice Address - Phone:919-200-5217
Practice Address - Fax:252-541-4002
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NCC0101281041C0700X
NCLCAS-22976101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)