Provider Demographics
NPI:1912382540
Name:MITCHELL, KASEY (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 DURHAM CHAPEL HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2829
Mailing Address - Country:US
Mailing Address - Phone:919-251-9001
Mailing Address - Fax:919-251-9010
Practice Address - Street 1:1011 SCHAUB DR
Practice Address - Street 2:STE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1862
Practice Address - Country:US
Practice Address - Phone:919-834-2000
Practice Address - Fax:919-834-2001
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical