Healthcare Provider Details

I. General information

NPI: 1164880282
Provider Name (Legal Business Name): LACARA GILMORE LLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15056 COLBERT ST 03
ROMULUS MI
48174
US

IV. Provider business mailing address

7310 WOODWARD AVE STE 601
DETROIT MI
48202-3165
US

V. Phone/Fax

Practice location:
  • Phone: 313-401-2655
  • Fax:
Mailing address:
  • Phone: 313-896-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006791
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: