Provider Demographics
NPI:1770223489
Name:GILL, MARY CLAIRE (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLAIRE
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MRS
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:BARCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWA
Mailing Address - Street 1:131 SPAIN DR
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-4574
Mailing Address - Country:US
Mailing Address - Phone:910-750-2629
Mailing Address - Fax:
Practice Address - Street 1:3806 PEACHTREE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6751
Practice Address - Country:US
Practice Address - Phone:910-750-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PO17415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health