Provider Demographics
NPI:1457311680
Name:GILL, BRIAN B (MAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
Last Name:GILL
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 19TH ST NW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1375
Mailing Address - Country:US
Mailing Address - Phone:202-246-9242
Mailing Address - Fax:
Practice Address - Street 1:1929 19TH ST NW UNIT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1375
Practice Address - Country:US
Practice Address - Phone:202-246-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50082192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health