Provider Demographics
NPI:1457919821
Name:GALLIMORE, YELITZA (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:YELITZA
Middle Name:
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 SIRIUS DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8455
Mailing Address - Country:US
Mailing Address - Phone:910-650-0288
Mailing Address - Fax:
Practice Address - Street 1:1608 QUEEN ST STE 1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5527
Practice Address - Country:US
Practice Address - Phone:910-673-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12628101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional