Provider Demographics
NPI:1568526762
Name:GILLIAM, ADINA H (LMFT)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:H
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2171
Mailing Address - Country:US
Mailing Address - Phone:828-230-8353
Mailing Address - Fax:
Practice Address - Street 1:109 HOLIDAY CT
Practice Address - Street 2:SUITE A2
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3000
Practice Address - Country:US
Practice Address - Phone:828-230-8353
Practice Address - Fax:973-916-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1144106H00000X
TNLMT0000000911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11741525OtherCAQH
NC6105150Medicaid