Provider Demographics
NPI:1093238446
Name:GILMORE, LOLITA RENEE' (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOLITA
Middle Name:RENEE'
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LOLITA
Other - Middle Name:R
Other - Last Name:GILMORE-RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR LOLITA GILMORE
Mailing Address - Street 1:201 GRACIE CT
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7481
Mailing Address - Country:US
Mailing Address - Phone:254-781-9900
Mailing Address - Fax:
Practice Address - Street 1:402 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5215
Practice Address - Country:US
Practice Address - Phone:254-519-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0087491041C0700X
TX13716101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)