Provider Demographics
NPI:1699193755
Name:GILLESPIE, DEBRA JOYCE (EDS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOYCE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 RISING HILL DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9404
Mailing Address - Country:US
Mailing Address - Phone:937-376-7729
Mailing Address - Fax:
Practice Address - Street 1:610 RISING HILL DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9404
Practice Address - Country:US
Practice Address - Phone:937-376-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist