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General NPI Number Information
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NPI Number | 1134758998
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Entity Type | Individual
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Provider Name | KIRSTIN CASSELL LCSW, LCAS
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Gender | Female
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 608 N GREENE ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2024
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Country | US
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Telephone | 336-790-4208
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Fax |
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Provider Business Mailing Address
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Address Line | 1852 BANKING ST
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City | GREENSBORO
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State | NC
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Zip | 27408-7222
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Country | US
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Telephone | 336-790-4208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C012281
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License Number State | NC
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