Provider Demographics
NPI:1710598586
Name:GILLESPIE, CANDACE L (ED D, NCC, LPC)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:L
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:ED D, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-9797
Mailing Address - Country:US
Mailing Address - Phone:662-588-2481
Mailing Address - Fax:
Practice Address - Street 1:829 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUND BAYOU
Practice Address - State:MS
Practice Address - Zip Code:38762-9797
Practice Address - Country:US
Practice Address - Phone:662-588-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6979101Y00000X
MS173503101YS0200X
MS1074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool