Provider Demographics
NPI:1982784872
Name:WEBSTER, MARY KASSANDRA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KASSANDRA
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 NASH ST NW STE G
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1712
Mailing Address - Country:US
Mailing Address - Phone:252-291-8909
Mailing Address - Fax:252-291-9223
Practice Address - Street 1:2231 NASH ST NW STE G
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1712
Practice Address - Country:US
Practice Address - Phone:252-291-8909
Practice Address - Fax:252-291-9223
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102152Medicaid