Provider Demographics
NPI:1912297565
Name:GAZAWAY, GINA RENAE (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:RENAE
Last Name:GAZAWAY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:RENAE
Other - Last Name:ALEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:15 ROBINS ROOST
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-6113
Mailing Address - Country:US
Mailing Address - Phone:361-894-5722
Mailing Address - Fax:
Practice Address - Street 1:2208 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8208
Practice Address - Country:US
Practice Address - Phone:910-634-0022
Practice Address - Fax:910-401-1774
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC8111101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health