Provider Demographics
NPI:1932956513
Name:GILLIAM, AMANI
Entity type:Individual
Prefix:
First Name:AMANI
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 RONAELE DR # 1
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1115
Mailing Address - Country:US
Mailing Address - Phone:215-868-4933
Mailing Address - Fax:
Practice Address - Street 1:35 EVANSBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3165
Practice Address - Country:US
Practice Address - Phone:484-854-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health