Provider Demographics
NPI:1346727559
Name:GALLAGHER, ROSE A (LCSW, LCAS-A)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9755
Mailing Address - Country:US
Mailing Address - Phone:305-807-2519
Mailing Address - Fax:
Practice Address - Street 1:6105 LAKEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2830
Practice Address - Country:US
Practice Address - Phone:305-807-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26416101YA0400X
NCP0127231041C0700X
NCC0136171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)