Provider Demographics
NPI:1891930160
Name:GIDENKO, YELENA (PHD, LPC, DCC)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:GIDENKO
Suffix:
Gender:F
Credentials:PHD, LPC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PRESTON EXECUTIVE DR STE 100E
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8488
Mailing Address - Country:US
Mailing Address - Phone:919-428-3196
Mailing Address - Fax:866-416-5628
Practice Address - Street 1:140 PRESTON EXECUTIVE DR STE 100E
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8488
Practice Address - Country:US
Practice Address - Phone:919-428-3196
Practice Address - Fax:866-416-5628
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104081Medicaid