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General NPI Number Information
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NPI Number | 1124124151
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Entity Type | Organization
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Legal Business Name | LISA J. KEITH, LCSW, PLLC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 112 ADLER LN
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City | GOLDSBORO
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State | NC
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Zip | 27530-5513
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Country | US
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Telephone | 919-580-0790
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Fax | 919-735-9238
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Provider Business Mailing Address
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Address Line | 112 ADLER LN
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City | GOLDSBORO
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State | NC
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Zip | 27530-5513
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Country | US
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Telephone | 919-580-0790
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Fax | 919-735-9238
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Authorized Official
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Title or Position | MANAGER/PARTNER
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Name | MRS. LISA JOHNSON KEITH
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Credential | LCSW
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Telephone | 919-922-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C002693
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License Number State | NC
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