Doctor Name: | MR. KEITH BRYAN COTTLE |
NPI Number: | 1043403637 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 854 |
Business Practice Address: | 404 Westwood Ave Suite 207 High Point, NC - 272624315 |
Business Phone Number: | 3368786042 |
Business Fax Number: | 3368786122 |
Mailing Address: | 404 Westwood Ave, Suite 207 HIGH POINT |
State: | NC |
Postal Code: | 272624315 |
Phone Number: | 3368786042 |
Fax Number: | 3368786122 |
NPI Enumeration Date: | 08/27/2007 |
NPI Last Update Date: | 08/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 854 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |