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General NPI Number Information
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NPI Number | 1629594197
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Entity Type | Individual
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Provider Name | GERREKA GILLIAM
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 200 CORPORATE POINT WALK SUITE 325
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City | CLOVER CITY
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State | CA
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Zip | 90230
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Country | US
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Telephone | 323-301-3449
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Fax | 213-481-1776
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Provider Business Mailing Address
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Address Line | 7381 LA TIJERA BLVD UNIT 452143
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City | LOS ANGELES
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State | CA
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Zip | 90045-7099
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Country | US
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Telephone | 323-301-3449
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Fax | 213-481-1776
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 106613
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 136323
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License Number State | CA
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