Provider Demographics
NPI:1073140695
Name:GIST, JEWELL E (LCSWA)
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:E
Last Name:GIST
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:JEWELL
Other - Middle Name:
Other - Last Name:GIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:2415 MORGANTON BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-9691
Mailing Address - Country:US
Mailing Address - Phone:828-394-5563
Mailing Address - Fax:828-394-5418
Practice Address - Street 1:2415 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9691
Practice Address - Country:US
Practice Address - Phone:828-394-5563
Practice Address - Fax:828-394-5418
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP014425101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health