Basic Information
| Provider Information | |||||||||
| NPI: | 1144678533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAYCEE | ||||||||
| FirstName: | SWEETIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KAYCEE | ||||||||
| OtherFirstName: | NATASHA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 615 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284126431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102025709 | ||||||||
| FaxNumber: | 9102029966 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 S WALKER ST | ||||||||
| Address2: | |||||||||
| City: | BURGAW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102590668 | ||||||||
| FaxNumber: | 9102594526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A12283 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.