Provider Demographics
NPI:1871070086
Name:GAUNT, CRENICIA JAILA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CRENICIA
Middle Name:JAILA
Last Name:GAUNT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 LILLY LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-3786
Mailing Address - Country:US
Mailing Address - Phone:252-767-1505
Mailing Address - Fax:
Practice Address - Street 1:943 W ANDREWS AVE STE H
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2562
Practice Address - Country:US
Practice Address - Phone:252-433-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0132611041C0700X
NCP0127701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical