Healthcare Provider Details

I. General information

NPI: 1407645211
Provider Name (Legal Business Name): KASEY LEIGH DEPRIEST CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASEY LEIGH ELLIS

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BERKMAR CIR
CHARLOTTESVILLE VA
22901-1464
US

IV. Provider business mailing address

705 PELHAM DR
WAYNESBORO VA
22980-1555
US

V. Phone/Fax

Practice location:
  • Phone: 434-400-9668
  • Fax: 434-465-6018
Mailing address:
  • Phone: 540-470-1621
  • Fax: 434-465-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: