Provider Demographics
NPI:1619539988
Name:GILHAM, CAITLIN (LPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:GILHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:SHOCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 N BELAIR SQ STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4322
Mailing Address - Country:US
Mailing Address - Phone:068-330-7807
Mailing Address - Fax:844-880-3086
Practice Address - Street 1:601 N BELAIR SQ STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4322
Practice Address - Country:US
Practice Address - Phone:706-833-0780
Practice Address - Fax:844-880-3086
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC005930OtherASSOCIATE PROFESSIONAL LICENSE