Provider Demographics
NPI:1285469825
Name:DAVIE, KAITLYN (LCSWA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DAVIE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 BURGUNDY BLUFF LANE
Mailing Address - Street 2:
Mailing Address - City:VEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597
Mailing Address - Country:US
Mailing Address - Phone:610-297-0705
Mailing Address - Fax:
Practice Address - Street 1:2740 NC 55 HWY # 210
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6209
Practice Address - Country:US
Practice Address - Phone:610-297-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP021025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health