Provider Demographics
NPI:1871864728
Name:MENDENHALL, GILLDA WALKER (MS)
Entity Type:Individual
Prefix:MS
First Name:GILLDA
Middle Name:WALKER
Last Name:MENDENHALL
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 1:200 SPRING GARDEN ST
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2737
Mailing Address - Country:US
Mailing Address - Phone:336-740-5284
Mailing Address - Fax:
Practice Address - Street 1:200 SPRING GARDEN ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2737
Practice Address - Country:US
Practice Address - Phone:336-740-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X, 171M00000X, 171W00000X, 174H00000X, 101Y00000X, 101YP1600X
NC77457723101YS0200X
FL4577345101YS0200X
NC457787642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty