Provider Demographics
NPI:1609143569
Name:GILL, DEVIN A (LMSW)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:A
Last Name:GILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:A
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:250 NELSON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1993
Mailing Address - Country:US
Mailing Address - Phone:231-425-4414
Mailing Address - Fax:231-425-4434
Practice Address - Street 1:250 NELSON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1993
Practice Address - Country:US
Practice Address - Phone:231-425-4414
Practice Address - Fax:231-425-4434
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010921341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical