Provider Demographics
NPI:1548635964
Name:GILLINS-HIGHSMITH, LAQUANDA MONIQUE (MS)
Entity type:Individual
Prefix:MRS
First Name:LAQUANDA
Middle Name:MONIQUE
Last Name:GILLINS-HIGHSMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 BROAD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9188
Mailing Address - Country:US
Mailing Address - Phone:904-994-8024
Mailing Address - Fax:
Practice Address - Street 1:4106 BROAD CREEK LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9188
Practice Address - Country:US
Practice Address - Phone:904-994-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health