Provider Demographics
NPI:1619047727
Name:WEAVER, PATRICIA GILLETTE (LPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GILLETTE
Last Name:WEAVER
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 1:3802 CLEMMONS RD # H
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8478
Mailing Address - Country:US
Mailing Address - Phone:336-462-0369
Mailing Address - Fax:
Practice Address - Street 1:3802 CLEMMONS RD # H
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8478
Practice Address - Country:US
Practice Address - Phone:336-462-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86161OtherNCBCBS PROVIDER #