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General NPI Number Information
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NPI Number | 1366572554
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Entity Type | Individual
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Provider Name | GAIL ELIZABETH GUSTAFSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 150 DAVIE ST
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City | PITTSBORO
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State | NC
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Zip | 27312-8833
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Country | US
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Telephone | 919-771-4535
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 531
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City | PITTSBORO
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State | NC
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Zip | 27312-0531
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Country | US
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Telephone | 919-771-4535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23712
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C007338
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License Number State | NC
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