Provider Demographics
NPI:1316018542
Name:SEACREST, KATHLEEN HINES (LPA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:HINES
Last Name:SEACREST
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:HINES
Other - Last Name:BROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPA
Mailing Address - Street 1:136 GEISKY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-5617
Mailing Address - Country:US
Mailing Address - Phone:828-835-0772
Mailing Address - Fax:
Practice Address - Street 1:136 GEISKY CREEK RD
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-5617
Practice Address - Country:US
Practice Address - Phone:828-835-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2566174400000X
NCNCLPA2566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107367Medicaid