Individual
MRS. CYVONNE RUSH GAINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
148-C E MORGAN ST., WADESBORO, NC 28170
(704) 458-0130
(704) 459-0130
Mailing address
148-C E MORGAN ST., WADESBORO, NC 28170
(704) 458-0130
(704) 459-0130
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1375
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6112112
—
NC
Enumeration date
06/15/2009
Last updated
07/18/2013
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