Provider Demographics
NPI:1811047640
Name:GAINEY, ALOYSIUS MARVIN (MA)
Entity type:Individual
Prefix:MR
First Name:ALOYSIUS
Middle Name:MARVIN
Last Name:GAINEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1751
Mailing Address - Street 2:805 SOUTH 8TH STREET
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-1751
Mailing Address - Country:US
Mailing Address - Phone:910-814-2147
Mailing Address - Fax:910-814-2331
Practice Address - Street 1:805 SOUTH STREET
Practice Address - Street 2:805 SOUTH STREET
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-1751
Practice Address - Country:US
Practice Address - Phone:910-814-2147
Practice Address - Fax:910-814-2331
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103239Medicaid