Provider Demographics
NPI:1689371064
Name:KASEY, GARY J (LCSWA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:KASEY
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1213 W MOREHEAD ST FL 5
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5576
Mailing Address - Country:US
Mailing Address - Phone:980-431-2375
Mailing Address - Fax:980-431-2378
Practice Address - Street 1:1213 W MOREHEAD ST FL 5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5576
Practice Address - Country:US
Practice Address - Phone:980-431-2375
Practice Address - Fax:980-431-2378
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP014532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health