Provider Demographics
NPI:1386992188
Name:GILLIAM, JAMILA MONIQUE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:JAMILA
Middle Name:MONIQUE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9603 CUSTER RD APT 1221
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6516
Mailing Address - Country:US
Mailing Address - Phone:817-460-9308
Mailing Address - Fax:
Practice Address - Street 1:9603 CUSTER RD # 1221
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-6516
Practice Address - Country:US
Practice Address - Phone:817-460-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56214104100000X
320900000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No171M00000XOther Service ProvidersCase Manager/Care Coordinator