Provider Demographics
NPI:1942409271
Name:MORILLO, IMILSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IMILSE
Middle Name:
Last Name:MORILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 ROBESON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5531
Mailing Address - Country:US
Mailing Address - Phone:910-826-3694
Mailing Address - Fax:910-826-3695
Practice Address - Street 1:1329 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5531
Practice Address - Country:US
Practice Address - Phone:910-826-3694
Practice Address - Fax:910-826-3695
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002157Medicaid