Provider Demographics
NPI:1811301336
Name:GILFILLAN, DAMEON (LADC)
Entity type:Individual
Prefix:
First Name:DAMEON
Middle Name:
Last Name:GILFILLAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2261
Mailing Address - Country:US
Mailing Address - Phone:402-301-5371
Mailing Address - Fax:402-475-7541
Practice Address - Street 1:421 S 9TH ST
Practice Address - Street 2:205
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2261
Practice Address - Country:US
Practice Address - Phone:402-301-5371
Practice Address - Fax:402-475-7541
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1079101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)