Provider Demographics
NPI:1124731559
Name:GABOUREL-DOCKERY, LISA TERESITA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:TERESITA
Last Name:GABOUREL-DOCKERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DOCKERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-1512
Mailing Address - Country:US
Mailing Address - Phone:919-703-3662
Mailing Address - Fax:866-737-9601
Practice Address - Street 1:4265 OFFSHORE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4899
Practice Address - Country:US
Practice Address - Phone:919-605-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care