Provider Demographics
NPI:1942989447
Name:WYMAN, KACEY (MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 FORTUNES RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9354
Mailing Address - Country:US
Mailing Address - Phone:209-298-1927
Mailing Address - Fax:
Practice Address - Street 1:224 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-2779
Practice Address - Country:US
Practice Address - Phone:919-663-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical