Provider Demographics
NPI:1982352373
Name:GILLIGAN, DEIRDRE (LICSW, PIP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:MARY
Other - Last Name:GILLIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW, PIP
Mailing Address - Street 1:PO BOX 72174
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35407-2174
Mailing Address - Country:US
Mailing Address - Phone:205-887-2657
Mailing Address - Fax:
Practice Address - Street 1:27 FERNWOOD CT
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-887-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1682-4706C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical