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Individual
MR. KEITH G PEMBERTON I
Active
Individual
MR. KEITH G PEMBERTON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, P-LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
P003878
NC
104100000X
Social Worker
P003878
NC
1041C0700X
Clinical Social Worker
Primary
P003878
NC
1041S0200X
School Social Worker
—
NC
Other
Enumeration date
08/27/2009
Last updated
08/27/2009
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