Provider Demographics
NPI:1386718658
Name:GENTILE, CHERYL (MS LPC CCAS CRC MAC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MS LPC CCAS CRC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 LYNNDALE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-752-8602
Mailing Address - Fax:252-752-8103
Practice Address - Street 1:620 LYNNDALE CT
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-752-8602
Practice Address - Fax:252-752-8103
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114101YA0400X
NCLPC 2055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC185968OtherMEDCOST
NC6102140Medicaid
NC1232LOtherBCBS