Provider Demographics
NPI:1639513062
Name:GILCHRIEST, JANICE M (MS)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:GILCHRIEST
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-0528
Mailing Address - Country:US
Mailing Address - Phone:850-702-7363
Mailing Address - Fax:
Practice Address - Street 1:20 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2428
Practice Address - Country:US
Practice Address - Phone:850-627-3434
Practice Address - Fax:850-627-3454
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health