Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003023540 |
---|---|
Provider Name | Misty Lee Gallimore |
First Address | Lawrenceburg, TN 38464-8401 |
Second Address | Lawrenceburg, TN 38464-8401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 29/12/2020 |