Provider Demographics
NPI:1386088086
Name:GIDDINS, JOSEPH JAMAL (LCSW,LICW-CP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMAL
Last Name:GIDDINS
Suffix:
Gender:M
Credentials:LCSW,LICW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N TRYON ST
Mailing Address - Street 2:STE 420 A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2704
Mailing Address - Country:US
Mailing Address - Phone:704-360-8909
Mailing Address - Fax:704-594-5616
Practice Address - Street 1:1801 N TRYON ST
Practice Address - Street 2:STE 420 A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2704
Practice Address - Country:US
Practice Address - Phone:704-360-8906
Practice Address - Fax:704-594-5616
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0093131041C0700X
SC111231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical