Provider Demographics
NPI:1417202342
Name:GALLAGHER, ANNAMARIE (LCMHCS)
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2716
Mailing Address - Country:US
Mailing Address - Phone:336-223-3784
Mailing Address - Fax:336-738-1253
Practice Address - Street 1:632 HOLLY AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2716
Practice Address - Country:US
Practice Address - Phone:336-223-3784
Practice Address - Fax:336-738-1253
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8143101YM0800X
NCS8143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health