Provider Demographics
NPI:1821761941
Name:BROWN-GILLIAM, ANNETTE CHERI (LSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CHERI
Last Name:BROWN-GILLIAM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7338
Mailing Address - Country:US
Mailing Address - Phone:219-614-6720
Mailing Address - Fax:219-736-9540
Practice Address - Street 1:8655 FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7338
Practice Address - Country:US
Practice Address - Phone:219-614-6720
Practice Address - Fax:219-736-9540
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009271A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty