Carissa Jennie Gill, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2006022 Issued in AR

Practice address

10025 W. Markham Street
Ste 210
Little Rock, AR 72205-2178

Phone

(501) 663-5473

Fax

(501) 801-1816

NPI assigned

Dec 2, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/lhsoutheast/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Living Hope Southeast, LLC

  • Mental Health Counselor
  • Monticello, AR
  • NPI 1689877862
  Medicare reassignment NPD
• Sparkfit Community Inc

  • Professional Counselor
  • Little Rock, AR
  • NPI 1417511387
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1053786004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10025 W. MARKHAM STREET",
            "address_2": "STE 210",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722052178",
            "telephone_number": "501-663-5473",
            "fax_number": "501-801-1816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10025 W. MARKHAM STREET",
            "address_2": "STE 210",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722052178",
            "telephone_number": "501-663-5473",
            "fax_number": "501-801-1816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILL",
        "first_name": "CARISSA",
        "middle_name": "JENNIE",
        "name_prefix": "Miss",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-02",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "A1511157",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2006022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Tullos Gildon, D.D.S.
• Iris Giles, LPC
• Stephon Giles, MHPP
• Tanya Giles
• Whitney Giles
• Federica Suree Gill, LMSW
• Jaime Gill, RN, CPN
• Jason Patrick Gillam, PHARMD
• Linsey Rose Gillam, PHARMD
• Emma Grace Gillaspy

• Professional Counselor in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.