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General NPI Number Information
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NPI Number | 1376809780
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Entity Type | Individual
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Provider Name | AGLAED M GILLIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 5815 20TH ST BLDG 213 SUITE 211
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5523
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Country | US
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Telephone | 703-805-5588
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Fax | 703-805-1065
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Provider Business Mailing Address
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Address Line | P.O. BOX 73
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City | FORT BELVOIR
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State | VA
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Zip | 22060-0073
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Country | US
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Telephone | 404-626-2048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW004742
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License Number State | GA
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