Provider Demographics
NPI:1679827984
Name:SYDALACK, BRITTANY GIBSON (LPCA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:GIBSON
Last Name:SYDALACK
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:RUTH
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-1866
Mailing Address - Country:US
Mailing Address - Phone:704-983-0911
Mailing Address - Fax:
Practice Address - Street 1:232 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4612
Practice Address - Country:US
Practice Address - Phone:704-983-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health