Provider Demographics
NPI:1891819777
Name:APPLE, GWEN G (LCAS,LPC)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:G
Last Name:APPLE
Suffix:
Gender:F
Credentials:LCAS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3729
Mailing Address - Country:US
Mailing Address - Phone:252-974-0760
Mailing Address - Fax:
Practice Address - Street 1:105 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4923
Practice Address - Country:US
Practice Address - Phone:252-975-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4993101YM0800X
NC1055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005246Medicaid