MEDICARE: AUDREY HELEN KEETON MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P008308	NC
2	1041C0700X	Clinical Social Worker	C009723	NC

General Provider Information

NPI Number	:	1679907851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY HELEN KEETON MSW, LCSW

Provider Business Mailing Address
First Line	:	4244 PINE HOLLOW DR.
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412
Country	:	US
Telephone Number	:	330-618-8544
Fax Number	:	910-202-9966

Provider Business Practice Location Address
First Line	:	3205 RANDALL PARKWAY
Second Line	:	STE 128
City	:	WILMINGTON
State	:	NC
Zip	:	28403
Country	:	US
Telephone Number	:	910-427-1845
Fax Number	:	910-782-4284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2013
Last Update Date	:	03/19/2026

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