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General NPI Number Information
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NPI Number | 1447588603
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Entity Type | Organization
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Legal Business Name | KEY BEHAVIOR ESSENTIALS, LLC
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 8300 FALLS OF NEUSE RD STE 108
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City | RALEIGH
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State | NC
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Zip | 27615-3450
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Country | US
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Telephone | 919-846-6800
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Fax | 919-846-6807
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Provider Business Mailing Address
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Address Line | 8300 FALLS OF NEUSE RD STE 108
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City | RALEIGH
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State | NC
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Zip | 27615-3450
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Country | US
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Telephone | 919-846-6800
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Fax | 919-846-6807
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Authorized Official
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Title or Position | COO/ PROGRAM MANAGER
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Name | MRS. AMESHULAH PROCTOR KEY
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Credential |
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Telephone | 919-801-7268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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