Healthcare Provider Details

I. General information

NPI: 1033000948
Provider Name (Legal Business Name): KACEY VICTORIA CLEARY LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 LONGTOWN RD
BOONVILLE NC
27011-8864
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 336-551-1160
  • Fax: 336-551-1159
Mailing address:
  • Phone: 704-730-7003
  • Fax: 704-865-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022365
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: