Basic Information
| Provider Information | |||||||||
| NPI: | 1982264099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAINEY | ||||||||
| FirstName: | MIRANDA | ||||||||
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| Credential: | LCSW-A, LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 CLANTON RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282171309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043329001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 MORGANTON BLVD SW | ||||||||
| Address2: | |||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286455219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286102740 | ||||||||
| FaxNumber: | 8287588633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2019 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-25727 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | P013587 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.