MEDICARE: LORETTA KEELIN COUNSELING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003027	NC

General Provider Information

NPI Number	:	1841421302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORETTA KEELIN COUNSELING, INC

Provider Business Mailing Address
First Line	:	824 GUM BRANCH RD
Second Line	:	SUITE O
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-6272
Country	:	US
Telephone Number	:	910-938-9338
Fax Number	:	910-989-0377

Provider Business Practice Location Address
First Line	:	824 GUM BRANCH RD
Second Line	:	SUITE O
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-6272
Country	:	US
Telephone Number	:	910-938-9338
Fax Number	:	910-989-0377

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	LORETTA B KEELIN
Credential	:	LCSW
Telephone Number	:	910-938-9338

Provider Enumeration Date	:	08/01/2009
Last Update Date	:	08/03/2009

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