Provider Demographics
NPI:1679167431
Name:DASTINE, ANNAIKA (LCSW)
Entity type:Individual
Prefix:
First Name:ANNAIKA
Middle Name:
Last Name:DASTINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNAIKA
Other - Middle Name:
Other - Last Name:ESTIVERNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 CARIBBEAN CT
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7108
Mailing Address - Country:US
Mailing Address - Phone:919-608-9717
Mailing Address - Fax:
Practice Address - Street 1:2000 PERIMETER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8442
Practice Address - Country:US
Practice Address - Phone:984-215-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0080591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical