Provider Demographics
NPI:1730127911
Name:GENTRY, DAVID WHELCHEL (MSSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WHELCHEL
Last Name:GENTRY
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-8924
Mailing Address - Country:US
Mailing Address - Phone:704-739-0365
Mailing Address - Fax:877-416-0624
Practice Address - Street 1:533 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-8924
Practice Address - Country:US
Practice Address - Phone:704-739-0365
Practice Address - Fax:877-416-0624
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002011Medicaid