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Individual

JAY GILLESPIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LICDC, SAP

Contact information

Practice address
1059 N MARKET ST, TROY, OH 45373-1433
(937) 335-4543
(937) 339-8371
Mailing address
1059 N MARKET ST, TROY, OH 45373-1433
(937) 335-4543
(937) 339-8371

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
933736
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2901051
OH
Enumeration date
07/11/2012
Last updated
07/11/2012
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