Provider Demographics
NPI:1679756191
Name:LIPPARD, GLADYS WILES
Entity type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:WILES
Last Name:LIPPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2749
Mailing Address - Country:US
Mailing Address - Phone:704-876-0272
Mailing Address - Fax:
Practice Address - Street 1:123 N CENTER ST
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2119
Practice Address - Country:US
Practice Address - Phone:828-635-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNBCC 219190101Y00000X
NBCC 219190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health