Provider Demographics
NPI:1508998493
Name:TAFFE, GINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:TAFFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 SIX FORKS ROAD
Mailing Address - Street 2:BUILDING 5, SUITE 505
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-589-2955
Mailing Address - Fax:
Practice Address - Street 1:6210 SIX FORKS ROAD
Practice Address - Street 2:BUILDING 5, SUITE 505
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-589-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003034101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC003034OtherSOCAL WORK LICENSE