Individual
DR. DEBRA JAPZON GILLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1540 PURDUE DR, SUITE 200, FAYETTEVILLE, NC 28303-5510
(901) 867-8889
(901) 867-8699
Mailing address
1540 PURDUE DR, SUITE 200, FAYETTEVILLE, NC 28303-5510
(901) 867-8889
(901) 867-8699
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1708
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0450T
BCBS
NC
05
—
6000388
—
NC
Enumeration date
10/04/2006
Last updated
06/22/2009
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