Individual
CARA JO GILLISPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
166356
—
104100000X
Social Worker
Primary
S.2004708
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0096642
—
ND
Enumeration date
06/22/2018
Last updated
12/17/2021
Update your record
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