Provider Demographics
NPI:1821121815
Name:IRRGANG, GLORIA KAY
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:KAY
Last Name:IRRGANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:NC
Mailing Address - Zip Code:28770-0040
Mailing Address - Country:US
Mailing Address - Phone:828-669-0011
Mailing Address - Fax:
Practice Address - Street 1:32 KNOX ROAD,
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:NC
Practice Address - Zip Code:28770
Practice Address - Country:US
Practice Address - Phone:828-669-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC661101YA0400X
NC3198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102687Medicaid