Provider Demographics
NPI:1326872235
Name:GAY, SHERESE CRYSTAL (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHERESE
Middle Name:CRYSTAL
Last Name:GAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 STONEYBROOK CT APT D2
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3454
Mailing Address - Country:US
Mailing Address - Phone:216-269-6179
Mailing Address - Fax:
Practice Address - Street 1:168 STONEYBROOK CT APT D2
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3454
Practice Address - Country:US
Practice Address - Phone:216-269-6179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health