Provider Demographics
NPI:1790522423
Name:EASLEY, KATHERINE A (LCSW-A)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:EASLEY
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 BELLOW ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3615
Mailing Address - Country:US
Mailing Address - Phone:704-999-2822
Mailing Address - Fax:
Practice Address - Street 1:3211 SHANNON RD STE 620
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6328
Practice Address - Country:US
Practice Address - Phone:919-886-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0208181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical