Provider Demographics
NPI:1477745982
Name:GILLESPIE, LAWRENCE D (LCSW)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-728-7112
Mailing Address - Fax:704-373-1604
Practice Address - Street 1:207 S BROAD STREET
Practice Address - Street 2:STE 1
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3189
Practice Address - Country:US
Practice Address - Phone:800-311-7072
Practice Address - Fax:704-662-0866
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0055651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical