Nicole Gilliam, SAC-IT, LPC-IT
Counselor, Addiction (Substance Use Disorder) in Kenosha, WI. Individual provider (NPI-1).
NPI number1487527156
StatusActive
Last updated in NPPESOct 8, 2025
Details
- NPI
- 1487527156
- Entity type
- Individual (NPI-1)
- Name
- Nicole Gilliam
- Credential
- SAC-IT, LPC-IT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 27, 2025
- Certification date
- Oct 8, 2025
- Last updated
- Oct 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 20912 | WI | Yes |
| 101YP2500X | Counselor, Professional | 8673 | WI |
Practice location
3825 39th Ave Ste 120Kenosha, WI 53144-2043
Phone 262-946-5752
Mailing address
3825 39th Ave Ste 120Kenosha, WI 53144-2043
Phone 262-946-5752 · Fax 262-946-5765
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All 30 Addiction (Substance Use Disorder) Counselor providers in Kenosha · All 2,489 providers in Kenosha
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