Provider Demographics
NPI:1881656965
Name:GILLS, DAVID EUGENE (LSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EUGENE
Last Name:GILLS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VOLANT
Mailing Address - State:PA
Mailing Address - Zip Code:16156-1301
Mailing Address - Country:US
Mailing Address - Phone:724-533-2433
Mailing Address - Fax:724-533-5485
Practice Address - Street 1:53 CREEK RD
Practice Address - Street 2:
Practice Address - City:VOLANT
Practice Address - State:PA
Practice Address - Zip Code:16156-1301
Practice Address - Country:US
Practice Address - Phone:724-533-2433
Practice Address - Fax:724-533-5485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005825E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA647842OtherHIGHMARK BLUE CROSS
PA141720OtherMAGELLEN
PA157733OtherVALUE OPTIONS