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General NPI Number Information
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NPI Number | 1578295804
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Entity Type | Individual
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Provider Name | VIVIANNE NICOLE KEYSER LCSWA
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 2620 TRYON COURTHOUSE RD
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City | BESSEMER CITY
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State | NC
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Zip | 28016-7646
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Country | US
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Telephone | 704-836-9107
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Fax | 704-629-5967
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Provider Business Mailing Address
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Address Line | 200 E 2ND AVE
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City | GASTONIA
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State | NC
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Zip | 28052-4358
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Country | US
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Telephone | 704-874-9005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P017754
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License Number State | NC
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