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General NPI Number Information
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NPI Number | 1386992188
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Entity Type | Individual
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Provider Name | JAMILA MONIQUE GILLIAM LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 9603 CUSTER RD # 1221
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City | PLANO
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State | TX
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Zip | 75025-6516
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Country | US
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Telephone | 817-460-9308
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Fax |
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Provider Business Mailing Address
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Address Line | 9603 CUSTER RD APT 1221
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City | PLANO
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State | TX
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Zip | 75025-6516
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Country | US
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Telephone | 817-460-9308
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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 | 56214
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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