Healthcare Provider Details

I. General information

NPI: 1033417654
Provider Name (Legal Business Name): KEITH GEORGE HELMKEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 03/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E MAIN ST SUITE 201
CANTON GA
30114-2785
US

IV. Provider business mailing address

250 E MAIN ST SUITE 201
CANTON GA
30114-2785
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax: 770-953-4740
Mailing address:
  • Phone: 770-953-4744
  • Fax: 770-953-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: