Provider Demographics
NPI:1366264459
Name:GARY, KISHAWNA DENAE (MSW, LCSW-A)
Entity type:Individual
Prefix:
First Name:KISHAWNA
Middle Name:DENAE
Last Name:GARY
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:KISHAWNA
Other - Middle Name:DENAE
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW-A
Mailing Address - Street 1:5108 ROCKY BRANCH DR APT 108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-5193
Mailing Address - Country:US
Mailing Address - Phone:828-817-3650
Mailing Address - Fax:
Practice Address - Street 1:1538 UNION RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2205
Practice Address - Country:US
Practice Address - Phone:704-864-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0215341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical