Provider Demographics
NPI:1669009841
Name:PRINCE, GWENDOLYN CHATTIN (MA QP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:CHATTIN
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MA QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 OLD CULLOWHEE RD
Mailing Address - Street 2:
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723-6914
Mailing Address - Country:US
Mailing Address - Phone:804-356-0449
Mailing Address - Fax:
Practice Address - Street 1:367 DELLWOOD RD STE A2
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3136
Practice Address - Country:US
Practice Address - Phone:828-454-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor