Provider Demographics
NPI:1104110162
Name:MCGILBERRY, JANICE LAKESHA
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LAKESHA
Last Name:MCGILBERRY
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 1:4 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4521
Mailing Address - Country:US
Mailing Address - Phone:919-908-9308
Mailing Address - Fax:919-287-2206
Practice Address - Street 1:1802 MARTIN LUTHER KING PKWY STE 107
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3586
Practice Address - Country:US
Practice Address - Phone:919-908-9308
Practice Address - Fax:919-287-2206
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8708101Y00000X
NC5024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor