Provider Demographics
NPI:1235420811
Name:GILLESPIE, SUSAN GENTZ (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GENTZ
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LAURA
Other - Last Name:GENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1250 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2603
Mailing Address - Country:US
Mailing Address - Phone:415-609-8205
Mailing Address - Fax:
Practice Address - Street 1:1250 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2603
Practice Address - Country:US
Practice Address - Phone:415-609-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38572101YM0800X
DC000140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health