Provider Demographics
NPI:1780791350
Name:GEORGESCU, GAIL DEBOSE (LPA)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DEBOSE
Last Name:GEORGESCU
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:MS
Other - First Name:SHEILA
Other - Middle Name:GAIL
Other - Last Name:DEBOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPA
Mailing Address - Street 1:1703 COUNTRY CLUB RD
Mailing Address - Street 2:STE 204 CAROLINA PSYCHOLOGICAL HEALTH SERVICES
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6006
Mailing Address - Country:US
Mailing Address - Phone:910-347-3010
Mailing Address - Fax:910-347-0740
Practice Address - Street 1:1703 COUNTRY CLUB RD
Practice Address - Street 2:STE 204 CAROLINA PSYCHOLOGICAL HEALTH SERVICES
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6006
Practice Address - Country:US
Practice Address - Phone:910-347-3010
Practice Address - Fax:910-347-0740
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23S9103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107421Medicaid
NC142KROtherBC/BS