Individual
MS. VIRGINIA I GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
125 NE 9TH ST, OAK ISLAND, NC 28465-6626
(910) 278-3355
Mailing address
125 NE 9TH ST, OAK ISLAND, NC 28465-6626
(910) 278-3355
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
353
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6111756
—
NC
Enumeration date
03/19/2007
Last updated
07/08/2007
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