Provider Demographics
NPI:1124124151
Name:LISA J. KEITH, LCSW, PLLC
Entity type:Organization
Organization Name:LISA J. KEITH, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-922-2055
Mailing Address - Street 1:112 ADLER LN
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-5513
Mailing Address - Country:US
Mailing Address - Phone:919-580-0790
Mailing Address - Fax:919-735-9238
Practice Address - Street 1:112 ADLER LN
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5513
Practice Address - Country:US
Practice Address - Phone:919-580-0790
Practice Address - Fax:919-735-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005936Medicaid
NC785920000OtherMAGELLAN
NC142JFOtherBCBS OF NC
NC190281OtherMEDCOST
NC6005936Medicaid
NC=========OtherPIEDMONT BEHAVIORAL HEALT
NC=========OtherCAROLINA BEHAVIORAL HEALT