MEDICARE: MR. GERALD W LANKFORD JR. MBA, MACC, MDIV, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	6654	NC
2	101YP2500X	Professional Counselor	6654	NC

General Provider Information

NPI Number	:	1194916288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD W LANKFORD JR. MBA, MACC, MDIV, LPC

Provider Business Mailing Address
First Line	:	1601 JONES FRANKLIN RD
Second Line	:	SUITE 104
City	:	RALEIGH
State	:	NC
Zip	:	27606-3379
Country	:	US
Telephone Number	:	919-851-1527
Fax Number	:	919-851-3555

Provider Business Practice Location Address
First Line	:	1601 JONES FRANKLIN RD
Second Line	:	SUITE 104
City	:	RALEIGH
State	:	NC
Zip	:	27606-3379
Country	:	US
Telephone Number	:	919-851-1527
Fax Number	:	919-851-3555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	11/21/2011

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