Provider Demographics
NPI:1114414992
Name:GILLILAND, DAVID HERBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HERBERT
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 CANYON FALLS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4841
Mailing Address - Country:US
Mailing Address - Phone:217-652-5051
Mailing Address - Fax:
Practice Address - Street 1:2752 CANYON FALLS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-4841
Practice Address - Country:US
Practice Address - Phone:217-652-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9701103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist