Provider Demographics
NPI:1427935659
Name:OWENS, MCKEITHAN DEWAYNE (LCADC)
Entity type:Individual
Prefix:MR
First Name:MCKEITHAN
Middle Name:DEWAYNE
Last Name:OWENS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:MR
Other - First Name:MCKEITHAN
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC
Mailing Address - Street 1:1000 FAWN DRIVE
Mailing Address - Street 2:1426
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094
Mailing Address - Country:US
Mailing Address - Phone:856-265-1708
Mailing Address - Fax:856-265-1708
Practice Address - Street 1:508 ATLANTIC AVE # 3381811
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1108
Practice Address - Country:US
Practice Address - Phone:856-338-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00184100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)