Provider Demographics
NPI:1770734626
Name:GILLIAM, CYNTHIA ANN (MFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 EL CAJON BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4466
Mailing Address - Country:US
Mailing Address - Phone:619-640-3266
Mailing Address - Fax:619-640-3269
Practice Address - Street 1:4660 EL CAJON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4466
Practice Address - Country:US
Practice Address - Phone:619-640-3266
Practice Address - Fax:619-640-3269
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist