Doctor Name: | BONNIE KAY GILLISPIE |
NPI Number: | 1598155251 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CDP - TRAINEE |
License Number: | CG60451727 |
Business Practice Address: | 710 Sw Rock Creek Dr. Stevenson, WA - 98648 |
Business Phone Number: | 5094273850 |
Business Fax Number: | 5094270188 |
Mailing Address: | Po Box 369, STEVENSON |
State: | WA |
Postal Code: | 98648 |
Phone Number: | 5094273850 |
Fax Number: | 5094270188 |
NPI Enumeration Date: | 02/02/2015 |
NPI Last Update Date: | 05/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CG60451727 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |