Individual
MR. FREDRICK GILLAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC-MHSP
Contact information
Practice address
815 EXOCET DR STE 107, CORDOVA, TN 38018-2257
(901) 230-2409
Mailing address
PO BOX 2911, CORDOVA, TN 38088-2911
(901) 230-2409
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0000003668
TN
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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