Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C005231 | NC |
NPI | 1003090846 |
---|---|
Provider Name | Carol D Kassey |
First Address | Wake Forest, NC 27587-5473 |
Second Address | Raleigh, NC 27609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 27/12/2007 |