Provider Demographics
NPI:1932705027
Name:GILLESPIE, MELINDA SUE (RMHCI)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25172 MERCEDES DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5539
Mailing Address - Country:US
Mailing Address - Phone:607-287-3959
Mailing Address - Fax:
Practice Address - Street 1:3191 HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6755
Practice Address - Country:US
Practice Address - Phone:941-883-4518
Practice Address - Fax:941-883-9583
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19192101YM0800X
FLMH20197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty