Provider Demographics
NPI:1265902837
Name:LINEBERGER, GREGORY DAVID SR (LPCA, NCC, MED)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAVID
Last Name:LINEBERGER
Suffix:SR
Gender:M
Credentials:LPCA, NCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SARDIS ROAD NORTH SUITE 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270
Mailing Address - Country:US
Mailing Address - Phone:704-565-9879
Mailing Address - Fax:
Practice Address - Street 1:1811 SARDIS ROAD NORTH SUITE 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270
Practice Address - Country:US
Practice Address - Phone:704-565-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1213460101YS0200X
NCA14323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool