Provider Demographics
NPI:1992041974
Name:GILMORE, WAKEELAH TAMIKKA (MSW/LCSW)
Entity Type:Individual
Prefix:
First Name:WAKEELAH
Middle Name:TAMIKKA
Last Name:GILMORE
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 1:28741 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:MARSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28363-8421
Mailing Address - Country:US
Mailing Address - Phone:910-206-9183
Mailing Address - Fax:
Practice Address - Street 1:548 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-484-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0121541041C0700X
NCP0067181041C0700X
NCCO130641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical