Provider Demographics
NPI:1710641246
Name:GILMORE-PARKS, NANCY (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:GILMORE-PARKS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ARMISTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4282
Mailing Address - Country:US
Mailing Address - Phone:910-382-5256
Mailing Address - Fax:
Practice Address - Street 1:104 ARMISTEAD WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4282
Practice Address - Country:US
Practice Address - Phone:910-382-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0102831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical