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General NPI Number Information
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NPI Number | 1134450174
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Entity Type | Organization
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Legal Business Name | J GALLIMORE MSW,LCSW,PLLC
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 3491 S EVANS ST SUITE A
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City | GREENVILLE
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State | NC
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Zip | 27834-4534
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Country | US
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Telephone | 252-378-1490
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | GRIFTON
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State | NC
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Zip | 28530-0179
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Country | US
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Telephone | 252-378-1490
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. JOAN ELLEN GALLIMORE
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Credential | MSW,LCSW,LCAS
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Telephone | 252-378-1490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C002860
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License Number State | NC
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