Provider Demographics
NPI:1437475365
Name:MCGILL, EVELYN B (MA, LCAS, LPC, CSI)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:B
Last Name:MCGILL
Suffix:
Gender:F
Credentials:MA, LCAS, LPC, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N YATES STREET
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052
Mailing Address - Country:US
Mailing Address - Phone:704-865-4308
Mailing Address - Fax:704-865-5525
Practice Address - Street 1:102 N YATES STREET
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052
Practice Address - Country:US
Practice Address - Phone:704-865-4308
Practice Address - Fax:704-865-5525
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
NC8853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112132Medicaid