Provider Demographics
NPI:1730472952
Name:BYNUM, GERALD HEYWARD (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:HEYWARD
Last Name:BYNUM
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 HARDIN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3518
Mailing Address - Country:US
Mailing Address - Phone:704-487-7583
Mailing Address - Fax:
Practice Address - Street 1:1104 HARDIN DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3518
Practice Address - Country:US
Practice Address - Phone:704-487-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical