Provider Demographics
NPI:1164446977
Name:DEVANE, KAREN CHURCH (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CHURCH
Last Name:DEVANE
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 1:3141 JOHN HUMPHRIES WYND
Mailing Address - Street 2:STE.275
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5438
Mailing Address - Country:US
Mailing Address - Phone:919-783-7272
Mailing Address - Fax:919-783-6480
Practice Address - Street 1:3141 JOHN HUMPHRIES WYND
Practice Address - Street 2:STE.275
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5438
Practice Address - Country:US
Practice Address - Phone:919-783-7272
Practice Address - Fax:919-783-6480
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0014581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical