Provider Demographics
NPI:1881100345
Name:BAINE, CASEY PAUL (LCAS, LPCA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:PAUL
Last Name:BAINE
Suffix:
Gender:F
Credentials:LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 KAYTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4329
Mailing Address - Country:US
Mailing Address - Phone:919-880-4078
Mailing Address - Fax:
Practice Address - Street 1:6103 KAYTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4329
Practice Address - Country:US
Practice Address - Phone:919-880-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23911101YA0400X
NC13442101YM0800X
NCA13442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)