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General NPI Number Information
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NPI Number | 1548336894
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Entity Type | Individual
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Provider Name | JOAN ELLEN GALLIMORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 311 JUDGES RD STE 4E
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City | WILMINGTON
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State | NC
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Zip | 28405-3655
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Country | US
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Telephone | 910-791-6767
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Fax | 910-791-6890
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Provider Business Mailing Address
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Address Line | 4300 SAPPHIRE CT 110
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City | GREENVILLE
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State | NC
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Zip | 27834-9079
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Country | US
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Telephone | 252-830-7561
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Fax | 252-413-0932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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