Provider Demographics
NPI:1164880282
Name:GILMORE, LACARA (LLMFT)
Entity Type:Individual
Prefix:
First Name:LACARA
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 WOODWARD AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3165
Mailing Address - Country:US
Mailing Address - Phone:313-896-1444
Mailing Address - Fax:
Practice Address - Street 1:15056 COLBERT ST
Practice Address - Street 2:03
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:313-401-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006791106H00000X
101YA0400X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)