Basic Information
| Provider Information | |||||||||
| NPI: | 1902909989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFMAN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LCMHCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2212 HWY 731 W | ||||||||
| Address2: | |||||||||
| City: | MOUNT GILEAD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043012821 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102956853 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 291 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | S2879 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 2879 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.