Provider Demographics
NPI:1982002614
Name:SQUILLACIOTI, GILLIAN ALOISIA
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:ALOISIA
Last Name:SQUILLACIOTI
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 1:1635 S DEKALB ST
Mailing Address - Street 2:APT 109
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152
Mailing Address - Country:US
Mailing Address - Phone:631-974-9403
Mailing Address - Fax:
Practice Address - Street 1:1635 S DEKALB ST
Practice Address - Street 2:APT 109
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152
Practice Address - Country:US
Practice Address - Phone:631-974-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11397101YM0800X
NY006155101YM0800X
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health