Healthcare Provider Details

I. General information

NPI: 1801121892
Provider Name (Legal Business Name): JESSICA KEELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COPPERFIELD BLVD NE
CONCORD NC
28025-2433
US

IV. Provider business mailing address

920 COPPERFIELD BLVD NE
CONCORD NC
28025-2433
US

V. Phone/Fax

Practice location:
  • Phone: 980-701-9900
  • Fax:
Mailing address:
  • Phone: 980-701-9900
  • Fax: 659-242-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP020280
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: