Provider Demographics
NPI:1316959463
Name:GILLAM, SHERRI LEE (LPC, LMFT, CSAC)
Entity type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:LEE
Last Name:GILLAM
Suffix:
Gender:M
Credentials:LPC, LMFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 KETTERING DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2448
Mailing Address - Country:US
Mailing Address - Phone:703-476-8158
Mailing Address - Fax:
Practice Address - Street 1:14150 PARKEAST CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2295
Practice Address - Country:US
Practice Address - Phone:703-968-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health