Healthcare Provider Details

I. General information

NPI: 1396236154
Provider Name (Legal Business Name): KEISHIA CECELIA HUCKS MS, LCMHC, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MALLOY ST STE B
GOLDSBORO NC
27534-4478
US

IV. Provider business mailing address

208 MALLOY ST STE B
GOLDSBORO NC
27534-4478
US

V. Phone/Fax

Practice location:
  • Phone: 984-520-6080
  • Fax: 984-520-6081
Mailing address:
  • Phone: 984-520-6080
  • Fax: 984-520-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19133
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28066
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: