Provider Demographics
NPI:1194126276
Name:GORE, REZELL (MSW, LCSW, LCAS, CCS)
Entity type:Individual
Prefix:MR
First Name:REZELL
Middle Name:
Last Name:GORE
Suffix:
Gender:M
Credentials:MSW, LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0485
Mailing Address - Country:US
Mailing Address - Phone:910-209-4332
Mailing Address - Fax:910-757-0041
Practice Address - Street 1:212 ELM ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2802
Practice Address - Country:US
Practice Address - Phone:910-209-4332
Practice Address - Fax:910-757-0041
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20470101YA0400X
NCC010441101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health