Provider Demographics
NPI:1700156551
Name:KEELY, JENNIFER ARCHER (MA, LMFT, LCAS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ARCHER
Last Name:KEELY
Suffix:
Gender:F
Credentials:MA, LMFT, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:284 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:101 COLVARD ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9797
Practice Address - Country:US
Practice Address - Phone:336-246-2109
Practice Address - Fax:336-246-2287
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1609106H00000X
NCLCAS-3211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)