Provider Demographics
NPI:1174096648
Name:REMILLARD, EMILY ROSE (LGPC)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 MASSACHUSETTS AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6006
Mailing Address - Country:US
Mailing Address - Phone:907-854-8270
Mailing Address - Fax:
Practice Address - Street 1:770 M ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3609
Practice Address - Country:US
Practice Address - Phone:202-547-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8846101YM0800X
DCLGPC00394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health