Provider Demographics
NPI:1699096602
Name:GARDNER, PATRICIA (MSCP, LPC, NCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSCP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BILOXI AVE
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9556
Mailing Address - Country:US
Mailing Address - Phone:336-926-4342
Mailing Address - Fax:
Practice Address - Street 1:1025 BILOXI AVE
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9556
Practice Address - Country:US
Practice Address - Phone:336-926-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional