Provider Demographics
NPI:1194916288
Name:LANKFORD, GERALD W JR (MBA, MACC, MDIV, LPC)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:W
Last Name:LANKFORD
Suffix:JR
Gender:M
Credentials:MBA, MACC, MDIV, LPC
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:LANKFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBA, MACC, ,LPC
Mailing Address - Street 1:1601 JONES FRANKLIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3379
Mailing Address - Country:US
Mailing Address - Phone:919-851-1527
Mailing Address - Fax:919-851-3555
Practice Address - Street 1:1601 JONES FRANKLIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3379
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:919-851-3555
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6654101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral