Provider Demographics
NPI:1093238446
Name:GILMORE, LOLITA RENEE' (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LOLITA
Middle Name:RENEE'
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LOLITA
Other - Middle Name:R
Other - Last Name:GILMORE-RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR LOLITA GILMORE
Mailing Address - Street 1:201 GRACIE CT
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7481
Mailing Address - Country:US
Mailing Address - Phone:254-781-9900
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-553-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13716101YA0400X
GACSW0087491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty