MEDICARE: AYANA GILHAM LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC007619	GA

General Provider Information

NPI Number	:	1538595228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANA GILHAM LPC, NCC

Provider Business Mailing Address
First Line	:	1501 BRIARLAKE CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-1284
Country	:	US
Telephone Number	:	678-536-9277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 BRIARLAKE CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-1285
Country	:	US
Telephone Number	:	678-536-9277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	10/29/2014

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