Provider Demographics
NPI:1215000195
Name:KASCSAK, THERESA M (LPC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:KASCSAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1973 GLENKIRK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9494
Mailing Address - Country:US
Mailing Address - Phone:704-650-0766
Mailing Address - Fax:
Practice Address - Street 1:212 N MARSHALL ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3006
Practice Address - Country:US
Practice Address - Phone:704-650-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104070Medicaid