Provider Demographics
NPI:1407645211
Name:DEPRIEST, KASEY LEIGH (CPRS)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LEIGH
Last Name:DEPRIEST
Suffix:
Gender:
Credentials:CPRS
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:LEIGH
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 PELHAM DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-1555
Mailing Address - Country:US
Mailing Address - Phone:540-470-1621
Mailing Address - Fax:434-465-6018
Practice Address - Street 1:631 BERKMAR CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1464
Practice Address - Country:US
Practice Address - Phone:434-400-9668
Practice Address - Fax:434-465-6018
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5035OtherCERTIFIED PEER RECOVERY SPECIALIST