Healthcare Provider Details

I. General information

NPI: 1932031507
Provider Name (Legal Business Name): CHARLES LESSIE GILL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 EE WALLACE BLVD N
FERRIDAY LA
71334-2209
US

IV. Provider business mailing address

701 EE WALLACE BLVD N
FERRIDAY LA
71334-2209
US

V. Phone/Fax

Practice location:
  • Phone: 318-437-7096
  • Fax: 318-437-7095
Mailing address:
  • Phone: 318-437-7096
  • Fax: 318-437-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: