Provider Demographics
NPI:1053795500
Name:GENTRY, BETHANY POPE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:POPE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 NC HIGHWAY 194 S
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-9412
Mailing Address - Country:US
Mailing Address - Phone:704-929-9751
Mailing Address - Fax:
Practice Address - Street 1:8076 NC HIGHWAY 105 S
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7333
Practice Address - Country:US
Practice Address - Phone:828-963-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0109681041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC010968OtherLCSW