MEDICARE: CHRISTINE GILMORE CAC, CCS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1612	LA

General Provider Information

NPI Number	:	1841760444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GILMORE CAC, CCS

Provider Business Mailing Address
First Line	:	927 ROBBIE ST
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-2506
Country	:	US
Telephone Number	:	225-394-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 ROBBIE ST
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-2506
Country	:	US
Telephone Number	:	225-394-9987
Fax Number	:

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

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	07/31/2025

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