Individual
KRISTINA LYNN GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
61607 29 PALMS HWY STE D, JOSHUA TREE, CA 92252-2391
(760) 366-8641
(760) 366-3365
Mailing address
61607 29 PALMS HWY STE D, JOSHUA TREE, CA 92252-2391
(760) 366-8641
(760) 366-3365
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
R1265160917
CA
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/28/2017
Last updated
09/30/2021
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