Healthcare Provider Details

I. General information

NPI: 1336088228
Provider Name (Legal Business Name): GRACEE KEITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6634 OLD STATESVILLE RD
CHARLOTTE NC
28269-6768
US

IV. Provider business mailing address

1223 5TH ST
STATESVILLE NC
28677-7107
US

V. Phone/Fax

Practice location:
  • Phone: 704-251-4898
  • Fax:
Mailing address:
  • Phone: 828-303-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: