Provider Demographics
NPI:1043956477
Name:DADUFALZA, KASSI JADE (LMFTA)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:JADE
Last Name:DADUFALZA
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 BULLARD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6833
Mailing Address - Country:US
Mailing Address - Phone:919-833-3312
Mailing Address - Fax:
Practice Address - Street 1:1008 BULLARD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6833
Practice Address - Country:US
Practice Address - Phone:919-833-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12374A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist