Provider Demographics
NPI:1013162056
Name:GISMONDI, JILLIAN ELIZABETH (MA LPC NCC)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:GISMONDI
Suffix:
Gender:F
Credentials:MA LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15370 LEVAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1903
Mailing Address - Country:US
Mailing Address - Phone:734-744-0170
Mailing Address - Fax:734-744-0171
Practice Address - Street 1:15370 LEVAN RD STE 2
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1903
Practice Address - Country:US
Practice Address - Phone:734-744-0170
Practice Address - Fax:734-744-0171
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional