Provider Demographics
NPI:1235000142
Name:GOMEZ, MARY (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 JONES FRANKLIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3379
Mailing Address - Country:US
Mailing Address - Phone:919-851-1527
Mailing Address - Fax:
Practice Address - Street 1:190 ROSEWOOD CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7628
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health