MEDICARE: MS. MICHELE ANN GALLAGHER LISW-CP-S

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	9761	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952310021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE ANN GALLAGHER LISW-CP-S

Provider Business Mailing Address
First Line	:	2676 HENAGAN LN
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-5440
Country	:	US
Telephone Number	:	910-520-8358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 HIGHWAY 17 N STE 102
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-6079
Country	:	US
Telephone Number	:	910-520-8358
Fax Number	:

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

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	02/24/2023

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