Provider Demographics
NPI:1235388547
Name:GALLUP, LORRAINE BROWN (LPC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:BROWN
Last Name:GALLUP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2093
Mailing Address - Country:US
Mailing Address - Phone:860-423-4279
Mailing Address - Fax:860-423-4284
Practice Address - Street 1:1185 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2093
Practice Address - Country:US
Practice Address - Phone:860-423-4279
Practice Address - Fax:860-423-4284
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional