Life Interrupted Counseling Services

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIFE INTERRUPTED COUNSELING SERVICES

Practice address

4045 N Tryon St Ste a
Charlotte, NC 28206

Phone

(980) 404-1069

Fax

(877) 766-6203

NPI assigned

May 20, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keshia Donuel Keith, PHD, LPCNPI 1013141043

Title

Owner

Phone

(980) 404-1069

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keshia Donuel Keith, PHD, LPCS, LPC

  • Professional Counselor
  • Chester, SC
  • NPI 1013141043
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1609433291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 HIGHLAND RIDGE PT",
            "city": "CLOVER",
            "state": "SC",
            "postal_code": "297105507",
            "telephone_number": "980-322-3466",
            "fax_number": "877-766-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 N TRYON ST STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28206",
            "telephone_number": "980-404-1069",
            "fax_number": "877-766-6203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 Highland Ridge Pt",
            "address_purpose": "LOCATION",
            "city": "Clover",
            "state": "SC",
            "postal_code": "297105507",
            "country_code": "US",
            "telephone_number": "980-404-1069",
            "fax_number": "877-766-6203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE INTERRUPTED COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-20",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "KEITH",
        "authorized_official_first_name": "KESHIA",
        "authorized_official_middle_name": "DONUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-404-1069",
        "authorized_official_credential": "PHD, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.