Provider Demographics
NPI:1053065649
Name:TUCKER, GEWYL KASY (LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:GEWYL
Middle Name:KASY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:GEWYL
Other - Middle Name:KASY
Other - Last Name:GALBERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC, NCC
Mailing Address - Street 1:242 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:242 E BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5325
Practice Address - Country:US
Practice Address - Phone:980-430-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional