Provider Demographics
NPI:1851585236
Name:GERBER, LORI ANNE (MS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:GERBER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SHARON LYNNE WAY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:828-452-1300
Mailing Address - Fax:828-627-1307
Practice Address - Street 1:33 SHARON LYNNE WAY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721
Practice Address - Country:US
Practice Address - Phone:828-452-1300
Practice Address - Fax:828-627-1307
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X
NC2246101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00000000000000OtherAPPLICANT-LICENSE PROFESSIONAL COUNSELOR
NC00000000000000000OtherPROVISIONAL LICENSE SUBSTANCE ABUSE COUNSELOT
NC2246OtherLCAS