Provider Demographics
NPI:1588120489
Name:KACI KRPEC PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:KACI KRPEC PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KACI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRPEC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-457-7730
Mailing Address - Street 1:1701 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4220
Mailing Address - Country:US
Mailing Address - Phone:646-457-7730
Mailing Address - Fax:
Practice Address - Street 1:21 W COLONY PL STE 130
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-7201
Practice Address - Country:US
Practice Address - Phone:646-457-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty