Provider Demographics
NPI:1386416949
Name:GALLARDO, MARIA MACARENA (LMFTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MACARENA
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 HENSLEY RD W
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-9004
Mailing Address - Country:US
Mailing Address - Phone:704-408-8489
Mailing Address - Fax:855-532-2779
Practice Address - Street 1:8201 ARROWRIDGE BLVD STE 148
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5865
Practice Address - Country:US
Practice Address - Phone:704-408-8489
Practice Address - Fax:855-532-2779
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10209A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist