Provider Demographics
NPI:1013572163
Name:GILLIAN, AMBER RAE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:GILLIAN
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:O'CALLAGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 SHADYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1145
Mailing Address - Country:US
Mailing Address - Phone:202-674-5181
Mailing Address - Fax:
Practice Address - Street 1:1505 SHADYWOOD CT
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1145
Practice Address - Country:US
Practice Address - Phone:202-674-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health