Individual
NICOLE GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT, LPC-IT
Contact information
Practice address
3825 39TH AVE STE 120, KENOSHA, WI 53144-2043
(262) 946-5752
Mailing address
3825 39TH AVE STE 120, KENOSHA, WI 53144-2043
(262) 946-5752
(262) 946-5765
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20912
WI
101YP2500X
Professional Counselor
8673
WI
Other
Enumeration date
09/27/2025
Last updated
10/08/2025
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