Provider Demographics
NPI:1952767071
Name:GILLESPIE, PATRICIA (LASAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 W CHANDLER BLVD APT 1234
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2530
Mailing Address - Country:US
Mailing Address - Phone:480-641-1165
Mailing Address - Fax:480-641-9026
Practice Address - Street 1:335 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE E
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4363
Practice Address - Country:US
Practice Address - Phone:480-641-1165
Practice Address - Fax:480-641-9026
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-5613T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)