Healthcare Provider Details

I. General information

NPI: 1467405563
Provider Name (Legal Business Name): MERRILYN ROSE GILL LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 SPRINGBANK LN SUITE G
CHARLOTTE NC
28226-3372
US

IV. Provider business mailing address

3315 SPRINGBANK LN STE 106
CHARLOTTE NC
28226-3198
US

V. Phone/Fax

Practice location:
  • Phone: 704-540-1706
  • Fax: 704-540-5866
Mailing address:
  • Phone: 704-540-1706
  • Fax: 980-819-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: