Provider Demographics
NPI:1861937955
Name:GILLES, ANGELA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GILLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5400 W LANDENS WAY APT 13A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9223
Mailing Address - Country:US
Mailing Address - Phone:309-966-0068
Mailing Address - Fax:309-966-0266
Practice Address - Street 1:5400 W LANDENS WAY APT 13A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9223
Practice Address - Country:US
Practice Address - Phone:309-966-0068
Practice Address - Fax:309-966-0266
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2021-04-26
Deactivation Date:2018-03-08
Deactivation Code:
Reactivation Date:2018-08-08
Provider Licenses
StateLicense IDTaxonomies
IL1490190121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical