Provider Demographics
NPI:1669719951
Name:GILLIAM, FOY BUTCH JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:FOY
Middle Name:BUTCH
Last Name:GILLIAM
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1970
Mailing Address - Country:US
Mailing Address - Phone:501-666-8686
Mailing Address - Fax:501-660-6830
Practice Address - Street 1:1521 MERRILL DR STE E200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1821
Practice Address - Country:US
Practice Address - Phone:501-660-6893
Practice Address - Fax:501-974-7798
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR7908C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical