Provider Demographics
NPI:1285777599
Name:ARLENE GEORGIA GALLAN PHD INC
Entity type:Organization
Organization Name:ARLENE GEORGIA GALLAN PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:GEORGIA
Authorized Official - Last Name:GALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-815-3535
Mailing Address - Street 1:3205 RANDALL PKWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2564
Mailing Address - Country:US
Mailing Address - Phone:910-815-3535
Mailing Address - Fax:866-293-1180
Practice Address - Street 1:3205 RANDALL PKWY
Practice Address - Street 2:SUITE 126
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2564
Practice Address - Country:US
Practice Address - Phone:910-815-3535
Practice Address - Fax:866-293-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000529Medicaid
NC6008371Medicaid
NC2492770BMedicare PIN
NC6000529Medicaid
NC2492770Medicare PIN