Healthcare Provider Details

I. General information

NPI: 1194185686
Provider Name (Legal Business Name): GINA ROSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA ROSE

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 H2O PL STE 11
HAMPSTEAD NC
28443
US

IV. Provider business mailing address

1144 WESTERN BLVD # 1122
JACKSONVILLE NC
28546-6651
US

V. Phone/Fax

Practice location:
  • Phone: 910-996-3115
  • Fax: 910-613-0016
Mailing address:
  • Phone: 910-996-3115
  • Fax: 910-613-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: