Provider Demographics
NPI:1245319474
Name:GASKINS, PENNY (MA)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:
Last Name:GASKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:
Practice Address - Street 1:IRONS BUILDING OGLESBY DRIVE
Practice Address - Street 2:CHILDREN'S DEVELOPMENTAL SE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-737-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1510103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046NUOtherBCBS NC