Doctor Name: | MARY GILLIAM-ANDRES |
NPI Number: | 1356626253 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., L.L.P.C. |
License Number: | 6401012360 |
Business Practice Address: | 5675 Fairview St Stevensville, MI - 491271033 |
Business Phone Number: | 2694297727 |
Business Fax Number: | 2694295754 |
Mailing Address: | 5675 Fairview St, STEVENSVILLE |
State: | MI |
Postal Code: | 491271033 |
Phone Number: | 2694297727 |
Fax Number: | 2694295754 |
NPI Enumeration Date: | 10/12/2011 |
NPI Last Update Date: | 10/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401012360 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |