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General NPI Number Information
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NPI Number | 1720368822
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Entity Type | Organization
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Legal Business Name | KEYSTONE COMMUNITY PARTNERS, INC.
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 2321 CRABTREE BLVD SUITE 250
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City | RALEIGH
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State | NC
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Zip | 27604-1567
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Country | US
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Telephone | 919-522-2508
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Fax |
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Provider Business Mailing Address
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Address Line | 3656 ROGERS RD SUITE 177
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City | WAKE FOREST
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State | NC
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Zip | 27587-9306
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Country | US
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Telephone | 919-832-1011
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Fax |
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Authorized Official
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Title or Position | ORGANIZATION ORGANIZER
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Name | MS. TANYA SMITH
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Credential | M.A, LCAS-A
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Telephone | 919-522-2508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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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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