Provider Demographics
NPI:1679621833
Name:MCCARTHY, GAEL DIANE-ELIZABETH (PHD, BCD)
Entity type:Individual
Prefix:DR
First Name:GAEL
Middle Name:DIANE-ELIZABETH
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PHD, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4509
Mailing Address - Country:US
Mailing Address - Phone:919-403-0398
Mailing Address - Fax:
Practice Address - Street 1:411 W CHAPEL HILL ST
Practice Address - Street 2:SUITE 908
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3616
Practice Address - Country:US
Practice Address - Phone:919-419-3474
Practice Address - Fax:919-419-3474
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003057Medicaid