Healthcare Provider Details

I. General information

NPI: 1811634322
Provider Name (Legal Business Name): BRITTANY GILLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11590 W BERNARDO CT STE 230
SAN DIEGO CA
92127-1624
US

IV. Provider business mailing address

710 W GRAND AVE UNIT 2101
ESCONDIDO CA
92025-2572
US

V. Phone/Fax

Practice location:
  • Phone: 619-733-6414
  • Fax:
Mailing address:
  • Phone: 571-758-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: