Healthcare Provider Details

I. General information

NPI: 1487585600
Provider Name (Legal Business Name): ABIGAIL GRACE GILLIS LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 ANSON WAY STE 254
RALEIGH NC
27615-3363
US

IV. Provider business mailing address

500 LAUREL SPRINGS DR APT 515
DURHAM NC
27713-6719
US

V. Phone/Fax

Practice location:
  • Phone: 704-832-2200
  • Fax: 704-838-1541
Mailing address:
  • Phone: 910-624-7780
  • Fax: 704-872-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: