Provider Demographics
NPI:1053888313
Name:KEITH, KRISTINE B (LPCA)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:B
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-5922
Mailing Address - Country:US
Mailing Address - Phone:910-520-0396
Mailing Address - Fax:
Practice Address - Street 1:133 NE 32ND ST
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-5922
Practice Address - Country:US
Practice Address - Phone:910-520-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1132225101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool