Marvin Theadore Keaton III, MA, LCMHCS, LCAS,CSI

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7790S Issued in NC

Practice address

6715 Hockett Country LN
Pleasant Garden, NC 27313-8262

Phone

(336) 508-0714

NPI assigned

Sep 23, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saved Health IncGroup PAC ID 2860823101, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saved Health Inc

  • Addiction Psychiatry Physician
  • High Point, NC
  • NPI 1740762160

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD
• Carr Vista Health Services, PLLC

  • Mental Health Counselor
  • Greensboro, NC
  • NPI 1508786187
  NPD (past) Authorized official
• Keaton Community Services PLLC

  • Addiction (Substance Use Disorder) Counselor
  • Pleasant Garden, NC
  • NPI 1124581392
  NPD (past) Authorized official

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1942518048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6715 HOCKETT COUNTRY LN",
            "city": "PLEASANT GARDEN",
            "state": "NC",
            "postal_code": "273138262",
            "telephone_number": "336-508-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6715 HOCKETT COUNTRY LN",
            "city": "PLEASANT GARDEN",
            "state": "NC",
            "postal_code": "273138262",
            "telephone_number": "336-508-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEATON",
        "first_name": "MARVIN",
        "middle_name": "THEADORE",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MA, LCMHCS, LCAS,CSI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-23",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-23799",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "7790S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danaja Hogan, LCSW-A
• Michael Shaun Johnston, PHARM D
• Monica Jones, LCMHCA
• Keaton Community Services PLLC
• April Keaton, SLP
• Donald Eric Kropski, COTA/L
• Londry & Modlin XV DDS PLLC (Pleasant Garden Dental)
• Sybil Lucas, PTA
• Nicholas Thomas Aivars Lukasevics, PTA
• Karen Meadows, LCMHCA

• Professional Counselor in Pleasant Garden, NC
• Providers in Pleasant Garden, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.