Provider Demographics
NPI:1992405583
Name:GILLIAM, ERWIN (LPC)
Entity type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14080 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5389
Mailing Address - Country:US
Mailing Address - Phone:228-343-3224
Mailing Address - Fax:
Practice Address - Street 1:14080 FOX HILL DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5389
Practice Address - Country:US
Practice Address - Phone:228-343-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional