Provider Demographics
NPI:1598294571
Name:GILLIARD, MICHAEL JEROME II (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:GILLIARD
Suffix:II
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LANTANA CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2211
Mailing Address - Country:US
Mailing Address - Phone:843-471-3511
Mailing Address - Fax:
Practice Address - Street 1:50 AVIATOR PLZ STE 105N
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-0140
Practice Address - Country:US
Practice Address - Phone:404-549-6987
Practice Address - Fax:404-795-5787
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health