| NPI | 1548731755 |
|---|---|
| Former Name | JAMIE NICOLE GILLISPIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE P-1613) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |