Provider Demographics
NPI:1871643643
Name:GILLESPIE, STEVEN DAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DAVIS
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PETTIGRU ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3028
Mailing Address - Country:US
Mailing Address - Phone:615-335-1269
Mailing Address - Fax:864-235-7503
Practice Address - Street 1:7 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3028
Practice Address - Country:US
Practice Address - Phone:615-335-1269
Practice Address - Fax:864-235-7503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN605106H00000X
SC1389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4112710OtherBLUE CROSS BLUE SHIELD