Provider Demographics
NPI:1104014976
Name:LEEGINS-VINSON, KATIE JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:JANE
Last Name:LEEGINS-VINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:154 BEACON DR
Practice Address - Street 2:SUITE I
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7995
Practice Address - Country:US
Practice Address - Phone:252-353-1114
Practice Address - Fax:252-353-1119
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0027151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical