Provider Demographics
NPI:1700338886
Name:GARY, DENETRA (LCSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:DENETRA
Middle Name:
Last Name:GARY
Suffix:
Gender:F
Credentials:LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 EXPRESS DR.
Mailing Address - Street 2:#19769 SMB#29685
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208
Mailing Address - Country:US
Mailing Address - Phone:910-216-4655
Mailing Address - Fax:
Practice Address - Street 1:8109 GARLAND AVE
Practice Address - Street 2:APT 2
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6851
Practice Address - Country:US
Practice Address - Phone:951-264-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500799111041C0700X
MD197781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical