Provider Demographics
NPI:1366794307
Name:EASTON, TOBY T (LPCA)
Entity type:Individual
Prefix:MR
First Name:TOBY
Middle Name:T
Last Name:EASTON
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ROYAL ANNE LN APT 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7813
Mailing Address - Country:US
Mailing Address - Phone:919-961-2892
Mailing Address - Fax:
Practice Address - Street 1:1037 BULLARD CT
Practice Address - Street 2:208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6871
Practice Address - Country:US
Practice Address - Phone:919-961-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-14
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional