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Individual
MRS. LEAH GILLAM
Active
Individual
MRS. LEAH GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
11682
LA
1041C0700X
Clinical Social Worker
Primary
61987
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
741801
LEGACY SITE MEDICARE #
—
Enumeration date
10/22/2015
Last updated
03/14/2016
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