Healthcare Provider Details

I. General information

NPI: 1104751601
Provider Name (Legal Business Name): LAUREN GISH MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S 15TH ST
WILMINGTON NC
28401-5532
US

IV. Provider business mailing address

311 S 15TH ST
WILMINGTON NC
28401-5532
US

V. Phone/Fax

Practice location:
  • Phone: 910-338-9789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: