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General NPI Number Information
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NPI Number | 1659032399
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Entity Type | Individual
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Provider Name | JILLIAN ELIZABETH GORMAN LPC, LSATP, CSAC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 8280 WILLOW OAKS CORPORATE DR STE 600
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City | FAIRFAX
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State | VA
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Zip | 22031-4516
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Country | US
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Telephone | 415-424-4266
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Fax | 415-520-6633
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Provider Business Mailing Address
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Address Line | 8300 ESTERS BLVD STE 900
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City | IRVING
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State | TX
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Zip | 75063-2233
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Country | US
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Telephone | 154-244-2664
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Fax | 415-520-6633
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710103769
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12841
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 0718000616
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701012663
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1477
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License Number State | NE
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701012663
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License Number State | VA
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