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General NPI Number Information
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NPI Number | 1942579271
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Entity Type | Individual
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Provider Name | KESSONGA GISCOMBE LCSWA
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Gender | Male
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 3708 LYCKAN PKWY STE 205
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City | DURHAM
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State | NC
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Zip | 27707-2586
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Country | US
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Telephone | 919-514-3566
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Fax |
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Provider Business Mailing Address
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Address Line | 117 EVERAM CT
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City | CHAPEL HILL
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State | NC
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Zip | 27516-6165
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Country | US
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Telephone | 919-451-4102
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 187
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License Number State | NC
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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 | P014845
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License Number State | NC
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