Healthcare Provider Details

I. General information

NPI: 1518601905
Provider Name (Legal Business Name): AUDREY ROSEMARY GALLAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36340 UNION LAKE RD APT 201
HARRISON TOWNSHIP MI
48045-6630
US

IV. Provider business mailing address

36340 UNION LAKE RD APT 201
HARRISON TOWNSHIP MI
48045-6630
US

V. Phone/Fax

Practice location:
  • Phone: 251-648-1944
  • Fax:
Mailing address:
  • Phone: 251-648-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119539
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6163C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: