Healthcare Provider Details

I. General information

NPI: 1104130632
Provider Name (Legal Business Name): GATEWAY COMMUNITY INITIATIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WINDEL DR 205
RALEIGH NC
27609-4475
US

IV. Provider business mailing address

2510 GARDEN HILL DR 303
RALEIGH NC
27614-6899
US

V. Phone/Fax

Practice location:
  • Phone: 919-896-4380
  • Fax: 800-991-0902
Mailing address:
  • Phone: 919-896-4380
  • Fax: 800-991-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA S PARKER
Title or Position: CLINICAL DIRECTOR
Credential: MSW, PLCSW, LCAS
Phone: 919-896-4380