Provider Demographics
NPI:1659940799
Name:GILLESPIE, EUGENE S (LLPC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:S
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:MR
Other - First Name:EUGENE
Other - Middle Name:S
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLPC
Mailing Address - Street 1:707 W MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2943
Mailing Address - Country:US
Mailing Address - Phone:313-833-2500
Mailing Address - Fax:
Practice Address - Street 1:707 W MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2943
Practice Address - Country:US
Practice Address - Phone:313-833-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health