Provider Demographics
NPI:1144678533
Name:KAYCEE, SWEETIE (LPCA)
Entity type:Individual
Prefix:
First Name:SWEETIE
Middle Name:
Last Name:KAYCEE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:KAYCEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:910-202-5709
Mailing Address - Fax:910-202-9966
Practice Address - Street 1:803 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425
Practice Address - Country:US
Practice Address - Phone:910-259-0668
Practice Address - Fax:910-259-4526
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health