Organization
1HOUSE OF MICAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMILA GILLIAM LBSW (OWNER)
(469) 478-7106
Entity
Organization
Contact information
Practice address
600 WOODBRIDGE PKWY, UNIT 2133, WYLIE, TX 75098-7047
(469) 478-7106
Mailing address
600 WOODBRIDGE PKWY, UNIT 2133, WYLIE, TX 75098-7047
(469) 478-7106
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
56214
TX
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
311Z00000X
Custodial Care Facility
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
03/17/2015
Last updated
03/17/2015
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