Provider Demographics
NPI:1518716729
Name:EASON, KEVIN BLAIR (MA, LCMHCA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BLAIR
Last Name:EASON
Suffix:
Gender:M
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8176
Mailing Address - Country:US
Mailing Address - Phone:919-862-3766
Mailing Address - Fax:
Practice Address - Street 1:700 CECIL ST STE 2026
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3255
Practice Address - Country:US
Practice Address - Phone:919-530-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health