Provider Demographics
NPI:1295123719
Name:LILLY, CATHERINE BLEVINS (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BLEVINS
Last Name:LILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 NEW WAVERLY PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7405
Mailing Address - Country:US
Mailing Address - Phone:252-481-8503
Mailing Address - Fax:
Practice Address - Street 1:570 NEW WAVERLY PL
Practice Address - Street 2:SUITE 210
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7405
Practice Address - Country:US
Practice Address - Phone:252-481-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical