Provider Demographics
NPI:1194704270
Name:GELLMAN, JACQUELINE (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:GELLMAN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BETHESDA PL
Mailing Address - Street 2:STE 103
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3323
Mailing Address - Country:US
Mailing Address - Phone:336-768-9768
Mailing Address - Fax:336-768-9557
Practice Address - Street 1:3000 BETHESDA PL
Practice Address - Street 2:STE 103
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3323
Practice Address - Country:US
Practice Address - Phone:336-768-9768
Practice Address - Fax:336-768-9557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical