Individual
JUENARRL KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
566 ROWE ST, ORANGEBURG, SC 29115-6720
(888) 992-5534
Mailing address
566 ROWE ST, ORANGEBURG, SC 29115-6720
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1961
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1961
—
SC
Enumeration date
11/16/2006
Last updated
06/21/2011
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