Provider Demographics
NPI:1326472952
Name:MENCY, GINA LATRELLE (LPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LATRELLE
Last Name:MENCY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MANTEO LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5002
Mailing Address - Country:US
Mailing Address - Phone:910-461-6968
Mailing Address - Fax:
Practice Address - Street 1:200 DOCTORS DR STE M
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-335-8344
Practice Address - Fax:910-968-0018
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health