Healthcare Provider Details

I. General information

NPI: 1013827336
Provider Name (Legal Business Name): JACKIE KEOTHAVY LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MONTFORD AVE
ASHEVILLE NC
28801-1015
US

IV. Provider business mailing address

16 RICH ST
ASHEVILLE NC
28806-3323
US

V. Phone/Fax

Practice location:
  • Phone: 828-888-0846
  • Fax: 828-372-5147
Mailing address:
  • Phone: 828-888-0846
  • Fax: 828-372-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: