Provider Demographics
NPI:1942579271
Name:GISCOMBE, KESSONGA (LCSWA)
Entity Type:Individual
Prefix:
First Name:KESSONGA
Middle Name:
Last Name:GISCOMBE
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 EVERAM CT
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6165
Mailing Address - Country:US
Mailing Address - Phone:919-451-4102
Mailing Address - Fax:
Practice Address - Street 1:3708 LYCKAN PKWY STE 205
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2586
Practice Address - Country:US
Practice Address - Phone:919-514-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC187171100000X
NCP0148451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist