Provider Demographics
NPI:1851001473
Name:GILLEY, PAMELA SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUZANNE
Last Name:GILLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S SAN SOUCI BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413
Mailing Address - Country:US
Mailing Address - Phone:678-878-8236
Mailing Address - Fax:
Practice Address - Street 1:217 S SAN SOUCI BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413
Practice Address - Country:US
Practice Address - Phone:678-878-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW20497OtherFLORIDA LICENSING