Basic Information
| Provider Information | |||||||||
| NPI: | 1760130488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | CASEY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10900 WORLD TRADE BLVD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276174202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192371337 | ||||||||
| FaxNumber: | 9192371625 | ||||||||
| Practice Location | |||||||||
| Address1: | 2076 NC HIGHWAY 42 W STE 230 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275205303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195535711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C011557 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.