Individual
TY'IONNA NICOLE GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1439 THUNDERBOLT DR, WALTERBORO, SC 29488-9341
(843) 539-2211
Mailing address
1439 THUNDERBOLT DR, WALTERBORO, SC 29488-9341
(843) 539-2211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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