Healthcare Provider Details

I. General information

NPI: 1043250871
Provider Name (Legal Business Name): ELIZABETH JENKINS GELL NCMFT NCLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIBBY JENKINS GELL NCMFT NCLPC

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 STOCKTIE RD
CHARLOTTE NC
28210-6475
US

IV. Provider business mailing address

3330 STOCKTIE RD
CHARLOTTE NC
28210-6475
US

V. Phone/Fax

Practice location:
  • Phone: 704-200-9282
  • Fax:
Mailing address:
  • Phone: 704-999-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3824
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number644
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: