Provider Demographics
NPI:1922660539
Name:MAJOR, GINA ELAINE
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ELAINE
Last Name:MAJOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 N DAVIDSON ST APT 421
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1286
Mailing Address - Country:US
Mailing Address - Phone:330-571-2465
Mailing Address - Fax:
Practice Address - Street 1:114 5TH AVE
Practice Address - Street 2:FL 2
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10011-5611
Practice Address - Country:US
Practice Address - Phone:929-294-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2001988101YP2500X
NY001127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0413656Medicaid