Provider Demographics
NPI:1225575459
Name:WEBBER, NATHAN KYLE (LPCA, MA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:KYLE
Last Name:WEBBER
Suffix:
Gender:M
Credentials:LPCA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4010
Mailing Address - Country:US
Mailing Address - Phone:434-471-0187
Mailing Address - Fax:
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor