Healthcare Provider Details

I. General information

NPI: 1508786187
Provider Name (Legal Business Name): CARR VISTA HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MUIRS CHAPEL RD STE 118
GREENSBORO NC
27410-6173
US

IV. Provider business mailing address

6715 HOCKETT COUNTRY LN
PLEASANT GARDEN NC
27313-8262
US

V. Phone/Fax

Practice location:
  • Phone: 336-508-0714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MARVIN THEADORE KEATON III
Title or Position: OWNER
Credential: MA, LMHCS, LCAS, CCS
Phone: 336-508-0714