Provider Demographics
NPI:1760412340
Name:GALLANT, CAROLE ELAINE (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ELAINE
Last Name:GALLANT
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 WENDRICK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3652
Mailing Address - Country:US
Mailing Address - Phone:248-851-1210
Mailing Address - Fax:248-626-1512
Practice Address - Street 1:43996 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5027
Practice Address - Country:US
Practice Address - Phone:248-338-2988
Practice Address - Fax:248-338-1322
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801066999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI028363OtherVALUE OPTIONS
MI0911419OtherBCBSM MESSA/MAGELLAN
MI1063603106OtherHEALTH PLUS PIN
MI20530OtherBCBS SA PIN
MI130958OtherCARE CHOICES/PREFERRED
MI258694OtherMHN PIN
MI7509104190OtherBCBSM MENTAL HEALTH PIN
MI1705289Medicaid
MI5266701OtherAETNA BEHAVIORAL HEALTH
MI5266701OtherAETNA BEHAVIORAL HEALTH