Provider Demographics
NPI:1194521039
Name:GODFREY, KASI JOY
Entity type:Individual
Prefix:
First Name:KASI
Middle Name:JOY
Last Name:GODFREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KASI
Other - Middle Name:JOY
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1861 DUCK HAVEN AVE SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3101
Mailing Address - Country:US
Mailing Address - Phone:910-520-0083
Mailing Address - Fax:
Practice Address - Street 1:10926 S TRYON ST STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4154
Practice Address - Country:US
Practice Address - Phone:980-353-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician