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General NPI Number Information
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NPI Number | 1942624580
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Entity Type | Organization
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Legal Business Name | PATRICK EDWARD GILLILAND, LLC
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 9635 VENTANA WAY SUITE 101
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8620
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Country | US
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Telephone | 678-366-8862
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Fax | 678-739-0119
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Provider Business Mailing Address
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Address Line | 9635 VENTANA WAY SUITE 101
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8620
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Country | US
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Telephone | 678-366-8862
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Fax | 678-739-0119
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MR. PATRICK EDWARD GILLILAND
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Credential | LMFT
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Telephone | 602-463-5673
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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 | MFT001143
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License Number State | GA
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