Provider Demographics
NPI:1619348018
Name:GILLIAM, AMANDA (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
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 1:4428 BUCKNELL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3100
Mailing Address - Country:US
Mailing Address - Phone:865-705-8079
Mailing Address - Fax:
Practice Address - Street 1:2202 AWARD WINNING WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1990
Practice Address - Country:US
Practice Address - Phone:865-705-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist