Provider Demographics
NPI:1598019473
Name:KEEFE, JOHNATHAN L
Entity type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:L
Last Name:KEEFE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 N. PEACE HAVEN ROAD
Mailing Address - Street 2:SUITE 274
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-577-0469
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1959 N. PEACE HAVEN ROAD
Practice Address - Street 2:SUITE 274
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-577-0469
Practice Address - Fax:704-939-1173
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC8138101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor