Provider Demographics
NPI:1538532502
Name:GILES, DEVON
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1803
Mailing Address - Country:US
Mailing Address - Phone:504-304-4097
Mailing Address - Fax:504-218-7962
Practice Address - Street 1:4700 WICHERS DR STE 205
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3054
Practice Address - Country:US
Practice Address - Phone:504-407-0709
Practice Address - Fax:504-333-6252
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA464581059Medicaid