Provider Demographics
NPI:1790055218
Name:HIRSH, GWEN (NC LMBT#6962)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:HIRSH
Suffix:
Gender:F
Credentials:NC LMBT#6962
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 LIGON MILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4987
Mailing Address - Country:US
Mailing Address - Phone:919-616-5839
Mailing Address - Fax:
Practice Address - Street 1:10431 LIGON MILL RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4987
Practice Address - Country:US
Practice Address - Phone:919-616-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker