Provider Demographics
NPI:1043250871
Name:GELL, ELIZABETH JENKINS (NCMFT NCLPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JENKINS
Last Name:GELL
Suffix:
Gender:F
Credentials:NCMFT NCLPC
Other - Prefix:MRS
Other - First Name:LIBBY
Other - Middle Name:JENKINS
Other - Last Name:GELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCMFT NCLPC
Mailing Address - Street 1:3330 STOCKTIE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6475
Mailing Address - Country:US
Mailing Address - Phone:704-999-8668
Mailing Address - Fax:
Practice Address - Street 1:3330 STOCKTIE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6475
Practice Address - Country:US
Practice Address - Phone:704-200-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3824101YP2500X
NC644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105007Medicaid