Healthcare Provider Details

I. General information

NPI: 1376833541
Provider Name (Legal Business Name): KEISHA M SAUNDERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEISHA M WALDRON LPC

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 W MEADOWVIEW RD SUITE 114
GREENSBORO NC
27407-3409
US

IV. Provider business mailing address

2211 W MEADOWVIEW RD SUITE 114
GREENSBORO NC
27407-3409
US

V. Phone/Fax

Practice location:
  • Phone: 336-451-9258
  • Fax:
Mailing address:
  • Phone: 336-451-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8721
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: