Doctor Name: | ELLIE VILANNA GAITHER |
NPI Number: | 1184089336 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 517 Deltona Blvd Ste A Deltona, FL - 327258016 |
Business Phone Number: | 3862595413 |
Business Fax Number: | |
Mailing Address: | 1032 Marlin Lakes Cir Apt 1235, SARASOTA |
State: | FL |
Postal Code: | 342326905 |
Phone Number: | 8043661370 |
Fax Number: | |
NPI Enumeration Date: | 12/15/2015 |
NPI Last Update Date: | 12/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |