Provider Demographics
NPI:1487860474
Name:GIAMBUSSO, JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:GIAMBUSSO
Suffix:
Gender:M
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:PO BOX 215
Mailing Address - Street 2:436 E. LONG AVE
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-0215
Mailing Address - Country:US
Mailing Address - Phone:704-853-8227
Mailing Address - Fax:
Practice Address - Street 1:436 E LONG AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2516
Practice Address - Country:US
Practice Address - Phone:704-853-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3761OtherNCBLPC LICENSE NUMBER