Healthcare Provider Details

I. General information

NPI: 1568372977
Provider Name (Legal Business Name): KELLY DENISE GILLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 9TH ST
RICHMOND VA
23219-1933
US

IV. Provider business mailing address

301 N 9TH ST
RICHMOND VA
23219-1933
US

V. Phone/Fax

Practice location:
  • Phone: 804-762-1932
  • Fax:
Mailing address:
  • Phone: 804-762-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: