Provider Demographics
NPI:1619420205
Name:GALLIMORE, MELISSA (MSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 LOCHY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7909
Mailing Address - Country:US
Mailing Address - Phone:704-618-4617
Mailing Address - Fax:
Practice Address - Street 1:7232 LOCHY LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7909
Practice Address - Country:US
Practice Address - Phone:704-618-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0101141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical