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General NPI Number Information
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NPI Number | 1598019473
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Entity Type | Individual
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Provider Name | MR. JOHNATHAN L KEEFE
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Gender | Male
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1959 N. PEACE HAVEN ROAD SUITE 274
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City | WINSTON-SALEM
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State | NC
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Zip | 27106
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Country | US
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Telephone | 336-577-0469
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Fax | 704-939-1173
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Provider Business Mailing Address
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Address Line | 1959 N. PEACE HAVEN ROAD SUITE 274
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City | WINSTON-SALEM
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State | NC
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Zip | 27106
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Country | US
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Telephone | 336-577-0469
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Fax | 704-939-1173
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 8138
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License Number State | NC
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