Provider Demographics
NPI:1629324975
Name:GYOERKOE, KEVIN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:GYOERKOE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8832 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6809
Mailing Address - Country:US
Mailing Address - Phone:704-631-3980
Mailing Address - Fax:
Practice Address - Street 1:8832 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6809
Practice Address - Country:US
Practice Address - Phone:704-631-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical