Provider Demographics
NPI:1689702243
Name:MCGILL, MARY JANE (LPC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 ARMSTRONG PARK DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4802
Mailing Address - Country:US
Mailing Address - Phone:704-854-9828
Mailing Address - Fax:
Practice Address - Street 1:412 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1538
Practice Address - Country:US
Practice Address - Phone:803-222-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52101YA0400X
NC5125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103046Medicaid
NC6103046Medicaid