Healthcare Provider Details

I. General information

NPI: 1033845284
Provider Name (Legal Business Name): BRIA GILLILAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 OLD SCIOTO TRL
PORTSMOUTH OH
45662-6642
US

IV. Provider business mailing address

4300 OLD SCIOTO TRL
PORTSMOUTH OH
45662-6642
US

V. Phone/Fax

Practice location:
  • Phone: 740-351-9298
  • Fax: 740-529-0553
Mailing address:
  • Phone: 740-351-9298
  • Fax: 740-529-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: