Provider Demographics
NPI:1467519132
Name:GITTINGS, MARION EASTON ALBURGER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:EASTON ALBURGER
Last Name:GITTINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 APOLLO DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3903
Mailing Address - Country:US
Mailing Address - Phone:910-470-2387
Mailing Address - Fax:910-791-5576
Practice Address - Street 1:5009A WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7045
Practice Address - Country:US
Practice Address - Phone:910-791-5575
Practice Address - Fax:910-791-5576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052051041C0700X
VA09040058441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142V7OtherBCBS
NC6106314Medicaid