Healthcare Provider Details

I. General information

NPI: 1932378619
Provider Name (Legal Business Name): RUSSELL KEENEY LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RUSS KEENEY LCMHC

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 N MAIN ST
CRAMERTON NC
28032-1414
US

IV. Provider business mailing address

PO BOX 550842
GASTONIA NC
28055-0842
US

V. Phone/Fax

Practice location:
  • Phone: 704-291-4173
  • Fax:
Mailing address:
  • Phone: 704-706-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5521
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: