Provider Demographics
NPI:1508306101
Name:GILLIAM, SHAMORA SHAW'NAE (MHS)
Entity Type:Individual
Prefix:MS
First Name:SHAMORA
Middle Name:SHAW'NAE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5998 VANCOUVER DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2046
Mailing Address - Country:US
Mailing Address - Phone:940-218-0355
Mailing Address - Fax:
Practice Address - Street 1:5998 VANCOUVER DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2046
Practice Address - Country:US
Practice Address - Phone:940-218-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator