Provider Demographics
NPI:1437828555
Name:SEGREST, ANNIE ELIZABETH (LCSW P014257)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:ELIZABETH
Last Name:SEGREST
Suffix:
Gender:F
Credentials:LCSW P014257
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2548
Mailing Address - Country:US
Mailing Address - Phone:919-414-7966
Mailing Address - Fax:
Practice Address - Street 1:702 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2548
Practice Address - Country:US
Practice Address - Phone:919-414-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP014257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty