Provider Demographics
NPI:1083977250
Name:GAY, YASMIN EVETTE (PHD, LCAS,LPC, CRC,)
Entity Type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:EVETTE
Last Name:GAY
Suffix:
Gender:F
Credentials:PHD, LCAS,LPC, CRC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 EMBARK DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7590
Mailing Address - Country:US
Mailing Address - Phone:336-785-3113
Mailing Address - Fax:
Practice Address - Street 1:725 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4180
Practice Address - Country:US
Practice Address - Phone:336-397-7500
Practice Address - Fax:336-397-7501
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001111176101Y00000X
NC11467101YP2500X
NC1847101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional