| Doctor Name: | ELIZA RACHELLE GEDGE |
| NPI Number: | 1003197658 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, TLLP |
| License Number: | 6301014858 |
| Business Practice Address: | 114 Orchard Lake Rd Pontiac, MI - 483412244 |
| Business Phone Number: | 2488587766 |
| Business Fax Number: | 2488587201 |
| Mailing Address: | 114 Orchard Lake Rd, PONTIAC |
| State: | MI |
| Postal Code: | 483412244 |
| Phone Number: | 2488587766 |
| Fax Number: | 2488587201 |
| NPI Enumeration Date: | 09/08/2011 |
| NPI Last Update Date: | 09/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 6301014858 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |