Healthcare Provider Details

I. General information

NPI: 1174574057
Provider Name (Legal Business Name): TRACEY TURNER-KEYSER MA, ADTR, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 US HIGHWAY 64 W SUITE 101
PITTSBORO NC
27312-6829
US

IV. Provider business mailing address

5089 US HIGHWAY 64 W SUITE 101
PITTSBORO NC
27312-6829
US

V. Phone/Fax

Practice location:
  • Phone: 919-545-9833
  • Fax: 919-545-9832
Mailing address:
  • Phone: 919-545-9833
  • Fax: 919-545-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4468
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: