Provider Demographics
NPI:1457051864
Name:GILMORE, VONDRIKA
Entity Type:Individual
Prefix:
First Name:VONDRIKA
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CENTER ST APT 15
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-1352
Mailing Address - Country:US
Mailing Address - Phone:803-899-4413
Mailing Address - Fax:
Practice Address - Street 1:301 CENTER ST APT 15
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-1352
Practice Address - Country:US
Practice Address - Phone:803-899-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst