Provider Demographics
NPI:1326201120
Name:GABODA, KAMAY H (LCMHCS LCAS, CCS)
Entity type:Individual
Prefix:
First Name:KAMAY
Middle Name:H
Last Name:GABODA
Suffix:
Gender:F
Credentials:LCMHCS 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 4
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-0004
Mailing Address - Country:US
Mailing Address - Phone:828-716-0962
Mailing Address - Fax:828-716-0962
Practice Address - Street 1:107 CHERRY MOUNTAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043
Practice Address - Country:US
Practice Address - Phone:828-716-0962
Practice Address - Fax:828-716-0962
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20023101YA0400X
NC7003101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103952Medicaid