Provider Demographics
NPI:1003142779
Name:GALLISON, LAUREN MARIE (MS, LPCA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:GALLISON
Suffix:
Gender:F
Credentials:MS, LPCA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:GRIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, QP
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-277-6050
Mailing Address - Fax:336-992-3141
Practice Address - Street 1:280 BROAD ST STE E
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2948
Practice Address - Country:US
Practice Address - Phone:336-277-6050
Practice Address - Fax:336-992-3141
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health