Provider Demographics
NPI:1952310021
Name:GALLAGHER, MICHELE ANN (LISW-CP-S)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LISW-CP-S
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ANN
Other - Last Name:LYMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCW
Mailing Address - Street 1:2676 HENAGAN LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5440
Mailing Address - Country:US
Mailing Address - Phone:910-520-8358
Mailing Address - Fax:
Practice Address - Street 1:1500 HIGHWAY 17 N STE 102
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6079
Practice Address - Country:US
Practice Address - Phone:910-520-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1412Medicaid