Healthcare Provider Details

I. General information

NPI: 1073447561
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER GILLIAM LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10712 BALLANTRAYE DR STE 304
FREDERICKSBURG VA
22407-4702
US

IV. Provider business mailing address

1218 CARODON DR
RUCKERSVILLE VA
22968-3186
US

V. Phone/Fax

Practice location:
  • Phone: 540-446-0007
  • Fax:
Mailing address:
  • Phone: 434-882-1476
  • Fax: 434-882-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: