MEDICARE: MISS CHRISTISHAWN REBECCA GORE MA 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	101YP2500X	Professional Counselor	10017	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	20477	NC

General Provider Information

NPI Number	:	1366884868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTISHAWN REBECCA GORE MA LPC

Provider Business Mailing Address
First Line	:	8303 PLANO CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-6640
Country	:	US
Telephone Number	:	919-824-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	8303 PLANO CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-6640
Country	:	US
Telephone Number	:	919-824-7789
Fax Number	:

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	02/28/2017

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