Provider Demographics
NPI:1750168092
Name:GILLIAM, LAMAR (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LAMAR
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 E ROOSEVELT BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2300
Mailing Address - Country:US
Mailing Address - Phone:215-939-9977
Mailing Address - Fax:
Practice Address - Street 1:8118 VERREE RD
Practice Address - Street 2:APT E208
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-939-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional