Provider Demographics
NPI:1144876558
Name:KEITH, PETER A (LCPC)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:KEITH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W CHESAPEAKE AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-9936
Mailing Address - Country:US
Mailing Address - Phone:443-863-0182
Mailing Address - Fax:
Practice Address - Street 1:305 W CHESAPEAKE AVE STE 505
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4421
Practice Address - Country:US
Practice Address - Phone:800-254-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional