=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124175500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATRINA ANN WATFORD GAMBLE MA,NCC,LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 LAMON ST STE 212
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-429-2222
-----------------------------------------------------
Fax | 910-429-2222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 64986 204 RUNWAY RD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-0986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-429-2222
-----------------------------------------------------
Fax | 910-429-2222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 6574
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------