Provider Demographics
NPI:1215142476
Name:GUPTILL, JANET L (MS, ATR-BC, LCAS)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:GUPTILL
Suffix:
Gender:F
Credentials:MS, ATR-BC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RIDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-8439
Mailing Address - Country:US
Mailing Address - Phone:731-661-1793
Mailing Address - Fax:
Practice Address - Street 1:23 RIDGESTONE DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-8439
Practice Address - Country:US
Practice Address - Phone:731-661-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
NC1762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist