Provider Demographics
NPI:1578989729
Name:GAMMON, HOLLY DANLEY (LMFT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DANLEY
Last Name:GAMMON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 VICTORIA FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9376
Mailing Address - Country:US
Mailing Address - Phone:336-675-6041
Mailing Address - Fax:
Practice Address - Street 1:4270 PIEDMONT PKWY STE 109
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8160
Practice Address - Country:US
Practice Address - Phone:336-675-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1745OtherNORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD