1174825467 NPI number — MS. GINA YVETTE BUSSEY LCSW LCAS CCS

Table of content: MS. GINA YVETTE BUSSEY LCSW LCAS CCS (NPI 1174825467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174825467 NPI number — MS. GINA YVETTE BUSSEY LCSW LCAS CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSSEY
Provider First Name:
GINA
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW LCAS CCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174825467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5057 NEUSE COMMONS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27616-8349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-825-6087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5057 NEUSE COMMONS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27616-8349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-825-6087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C014673 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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