Provider Demographics
NPI:1700412657
Name:GILLIGAN, DAMARYS J (EDD, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:DAMARYS
Middle Name:J
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:EDD, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 PINES BLVD # 2042
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-9200
Mailing Address - Country:US
Mailing Address - Phone:954-372-8007
Mailing Address - Fax:
Practice Address - Street 1:285 NW 164TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1131
Practice Address - Country:US
Practice Address - Phone:954-372-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health