Provider Demographics
NPI:1942755517
Name:GILLIS, JOANNA LESLI (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LESLI
Last Name:GILLIS
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 1:1940 CENTURY PARK E
Mailing Address - Street 2:SUITE 425
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-1700
Mailing Address - Country:US
Mailing Address - Phone:310-896-8427
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1406
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2017
Practice Address - Country:US
Practice Address - Phone:310-896-8427
Practice Address - Fax:310-268-1015
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical