Provider Demographics
NPI:1215449012
Name:COTTO, KEIRSTIN (LCMHCA, LCAS, CSI)
Entity type:Individual
Prefix:
First Name:KEIRSTIN
Middle Name:
Last Name:COTTO
Suffix:
Gender:F
Credentials:LCMHCA, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 RINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823-8186
Mailing Address - Country:US
Mailing Address - Phone:646-221-0965
Mailing Address - Fax:
Practice Address - Street 1:104 ZEBULON CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2420
Practice Address - Country:US
Practice Address - Phone:252-972-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14458101YM0800X
NCLCAS24041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health