Healthcare Provider Details

I. General information

NPI: 1053065649
Provider Name (Legal Business Name): GEWYL KASY TUCKER LCMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEWYL KASY GALBERTH LCMHC, NCC

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 E BROAD ST
STATESVILLE NC
28677-5325
US

IV. Provider business mailing address

242 E BROAD ST
STATESVILLE NC
28677-5325
US

V. Phone/Fax

Practice location:
  • Phone: 980-430-9205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17352
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: