Provider Demographics
NPI:1174846596
Name:GUILLORY, TAMARA E (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:E
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:E
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:107 14TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6403
Mailing Address - Country:US
Mailing Address - Phone:513-373-2843
Mailing Address - Fax:
Practice Address - Street 1:107 14TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6403
Practice Address - Country:US
Practice Address - Phone:513-373-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10003671041C0700X
DCLC500790521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical