Provider Demographics
NPI:1427721158
Name:GILMORE, LANISSA YVETTE (LMSW)
Entity type:Individual
Prefix:
First Name:LANISSA
Middle Name:YVETTE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KIERRE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-3708
Mailing Address - Country:US
Mailing Address - Phone:501-503-8624
Mailing Address - Fax:501-257-3060
Practice Address - Street 1:2200 FORT ROOTS DR RM 1H112
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3345
Practice Address - Fax:501-257-3060
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8863-LM104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker