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General NPI Number Information
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NPI Number | 1508786187
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Entity Type | Organization
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Legal Business Name | CARR VISTA HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 204 MUIRS CHAPEL RD STE 118
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City | GREENSBORO
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State | NC
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Zip | 27410-6173
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Country | US
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Telephone | 336-508-0714
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 HOCKETT COUNTRY LN
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City | PLEASANT GARDEN
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State | NC
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Zip | 27313-8262
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARVIN THEADORE KEATON III
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Credential | MA, LMHCS, LCAS, CCS
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Telephone | 336-508-0714
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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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