Provider Demographics
NPI:1134450174
Name:J GALLIMORE MSW,LCSW,PLLC
Entity type:Organization
Organization Name:J GALLIMORE MSW,LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GALLIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW,LCAS
Authorized Official - Phone:252-378-1490
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:GRIFTON
Mailing Address - State:NC
Mailing Address - Zip Code:28530-0179
Mailing Address - Country:US
Mailing Address - Phone:252-378-1490
Mailing Address - Fax:
Practice Address - Street 1:3491 S EVANS ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4534
Practice Address - Country:US
Practice Address - Phone:252-378-1490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1179FOtherBCBS
NC6007022Medicaid
NC2048510OtherCIGNA BEHAV HEALTH
NC187374OtherMEDCOST
NC6007022Medicaid