Provider Demographics
NPI:1346972742
Name:WEAVER, CASEY ELISABETH
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:ELISABETH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5704 MEDLIN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-7499
Mailing Address - Country:US
Mailing Address - Phone:843-496-1766
Mailing Address - Fax:
Practice Address - Street 1:5704 MEDLIN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-7499
Practice Address - Country:US
Practice Address - Phone:843-496-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1241465101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool