Individual
MR. MARVIN THEADORE KEATON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCMHCS, LCAS,CSI
Contact information
Practice address
6715 HOCKETT COUNTRY LN, PLEASANT GARDEN, NC 27313-8262
(336) 508-0714
Mailing address
6715 HOCKETT COUNTRY LN, PLEASANT GARDEN, NC 27313-8262
(336) 508-0714
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-23799
NC
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
7790S
NC
Other
Enumeration date
09/23/2010
Last updated
05/25/2021
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