Provider Demographics
NPI:1710946629
Name:AUSTIN, GWYNNETH JONES (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GWYNNETH
Middle Name:JONES
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329A SANFORD DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2555
Mailing Address - Country:US
Mailing Address - Phone:828-430-9120
Mailing Address - Fax:828-430-9122
Practice Address - Street 1:201 GOVERNMENT AVE SW
Practice Address - Street 2:SUITE 305
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602
Practice Address - Country:US
Practice Address - Phone:828-754-1344
Practice Address - Fax:828-430-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102478Medicaid
NC4818OtherNC LICENSE