Provider Demographics
NPI:1912037615
Name:GILL, ELIZABETH (LPCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 VILLAGE WAY STE 1A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5116
Mailing Address - Country:US
Mailing Address - Phone:330-655-2674
Mailing Address - Fax:
Practice Address - Street 1:72 VILLAGE WAY STE 1A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5116
Practice Address - Country:US
Practice Address - Phone:330-655-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health