Provider Demographics
NPI:1477812311
Name:GILL, VANESSA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S HIGHWAY 78
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3944
Mailing Address - Country:US
Mailing Address - Phone:469-342-3468
Mailing Address - Fax:469-342-3466
Practice Address - Street 1:303 S HIGHWAY 78
Practice Address - Street 2:SUITE 100
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3944
Practice Address - Country:US
Practice Address - Phone:469-342-3468
Practice Address - Fax:469-342-3466
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX503581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical