Provider Demographics
NPI:1871367755
Name:GILMORE, CAROLINE OWEN (MA, LCMHA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:OWEN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MA, LCMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 DUBLIN SQUARE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-8601
Mailing Address - Country:US
Mailing Address - Phone:336-860-3262
Mailing Address - Fax:336-521-7550
Practice Address - Street 1:138 DUBLIN SQUARE RD STE A
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8601
Practice Address - Country:US
Practice Address - Phone:336-860-3262
Practice Address - Fax:336-521-7550
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health