Provider Demographics
NPI:1992905244
Name:CANTRELL, HAROLD KEITH (LPC)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:KEITH
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0500
Mailing Address - Country:US
Mailing Address - Phone:828-443-1225
Mailing Address - Fax:828-368-0208
Practice Address - Street 1:320 EAST HWY 70
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9500
Practice Address - Country:US
Practice Address - Phone:828-443-1225
Practice Address - Fax:828-368-0208
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103655Medicaid
NC146MNOtherBCBS