Basic Information
| Provider Information | |||||||||
| NPI: | 1467647701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILKESSON | ||||||||
| FirstName: | REGINALD | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3411 BETTERTON LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282690154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042223443 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1305 S CANNON BLVD | ||||||||
| Address2: | |||||||||
| City: | KANNAPOLIS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280836232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | C014200 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | P013868 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.