Provider Demographics
NPI:1225759277
Name:GAMBRELL, BETH (LCASA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 LEES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-1624
Mailing Address - Country:US
Mailing Address - Phone:336-317-7834
Mailing Address - Fax:
Practice Address - Street 1:709 E MARKET ST STE 100B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3282
Practice Address - Country:US
Practice Address - Phone:336-378-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24993101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)