Provider Demographics
NPI:1942997986
Name:GIFT, KIYEKA (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:KIYEKA
Middle Name:
Last Name:GIFT
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7204
Mailing Address - Country:US
Mailing Address - Phone:910-787-3112
Mailing Address - Fax:
Practice Address - Street 1:445 WESTERN BLVD STE Q
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6852
Practice Address - Country:US
Practice Address - Phone:910-858-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health