Healthcare Provider Details

I. General information

NPI: 1346187564
Provider Name (Legal Business Name): ERICA NICOLE GILLISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N BOONE ST STE 600
JOHNSON CITY TN
37604-5675
US

IV. Provider business mailing address

1229 BROAD ST
ELIZABETHTON TN
37643-2407
US

V. Phone/Fax

Practice location:
  • Phone: 865-338-5384
  • Fax: 865-338-5383
Mailing address:
  • Phone: 607-590-6830
  • 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: