Provider Demographics
NPI:1174825467
Name:BUSSEY, GINA YVETTE (LCSW LCAS CCS)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:YVETTE
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:LCSW LCAS CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 NEUSE COMMONS LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8349
Mailing Address - Country:US
Mailing Address - Phone:919-825-6087
Mailing Address - Fax:
Practice Address - Street 1:5057 NEUSE COMMONS LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-8349
Practice Address - Country:US
Practice Address - Phone:919-825-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0146731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical