MEDICARE: LAUREN GISH MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C020102	NC

General Provider Information

NPI Number	:	1104751601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN GISH MSW, LCSW

Provider Business Mailing Address
First Line	:	311 S 15TH ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-5532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 S 15TH ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-5532
Country	:	US
Telephone Number	:	910-338-9789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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