Individual
MISS JILLIAN ELIZABETH GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LSATP, CSAC
Contact information
Practice address
8280 WILLOW OAKS CORPORATE DR STE 600, FAIRFAX, VA 22031-4516
(415) 424-4266
(415) 520-6633
Mailing address
8300 ESTERS BLVD STE 900, IRVING, TX 75063-2233
(154) 244-2664
(415) 520-6633
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710103769
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
1477
NE
101YM0800X
Mental Health Counselor
0701012663
VA
101YM0800X
Mental Health Counselor
12841
NE
101YP2500X
Professional Counselor
Primary
0701012663
VA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
0718000616
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10027432500
—
NE
01
—
1477272912
NPI 2- GROUP
NE
Enumeration date
01/05/2022
Last updated
01/03/2025
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