Provider Demographics
NPI:1063603942
Name:DIVELY, CATHY C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:C
Last Name:DIVELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2719 GRAVES DR
Mailing Address - Street 2:STE 5
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4536
Mailing Address - Country:US
Mailing Address - Phone:919-330-4367
Mailing Address - Fax:919-330-4375
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6118
Practice Address - Fax:919-731-6133
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical