Provider Demographics
NPI:1801505821
Name:GILMORE-WILLIAMS, CHARLOTTE DENISE
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:DENISE
Last Name:GILMORE-WILLIAMS
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 1:1711 N SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4324
Mailing Address - Country:US
Mailing Address - Phone:773-718-0794
Mailing Address - Fax:
Practice Address - Street 1:1711 N SAYRE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4324
Practice Address - Country:US
Practice Address - Phone:773-718-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0187061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical