Provider Demographics
NPI:1548533227
Name:MOBLEY-GILMORE, CHRISSY ANNA (LPC, RN)
Entity type:Individual
Prefix:MRS
First Name:CHRISSY
Middle Name:ANNA
Last Name:MOBLEY-GILMORE
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:ANNA
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 TINGLE CIR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-7315
Mailing Address - Country:US
Mailing Address - Phone:864-357-0668
Mailing Address - Fax:
Practice Address - Street 1:114 TINGLE CIR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-7315
Practice Address - Country:US
Practice Address - Phone:864-357-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6068101Y00000X
SC229569163WA2000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator