Provider Demographics
NPI:1962882662
Name:DUFFY, KATIE MARIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:DUFFY
Other - Last Name:CATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-A
Mailing Address - Street 1:2407 CHESTNUT RIDGE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243-9723
Mailing Address - Country:US
Mailing Address - Phone:919-899-6259
Mailing Address - Fax:
Practice Address - Street 1:3040 HAMMOND BUSINESS PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3666
Practice Address - Country:US
Practice Address - Phone:919-899-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0087151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical