Provider Demographics
NPI:1821257692
Name:GAGNON, CAROL CLAIRE (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CLAIRE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 SHADY GLEN TRAIL
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8832
Mailing Address - Country:US
Mailing Address - Phone:919-477-1900
Mailing Address - Fax:
Practice Address - Street 1:6303 SHADY GLEN TRL
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8832
Practice Address - Country:US
Practice Address - Phone:919-477-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional