Provider Demographics
NPI:1366884868
Name:GORE, CHRISTISHAWN REBECCA (MA LPC)
Entity type:Individual
Prefix:MISS
First Name:CHRISTISHAWN
Middle Name:REBECCA
Last Name:GORE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 PLANO CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6640
Mailing Address - Country:US
Mailing Address - Phone:919-824-7789
Mailing Address - Fax:
Practice Address - Street 1:8303 PLANO CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6640
Practice Address - Country:US
Practice Address - Phone:919-824-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10017101YP2500X
NC20477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)