Individual
MISS CORLISS GILLESPIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
12531 CLIPPER DR, WOODBRIDGE, VA 22192-2355
(571) 402-2509
Mailing address
PO BOX 4090, WOODBRIDGE, VA 22194-4090
(678) 640-3947
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
LPC004645
GA
Other
Enumeration date
03/06/2007
Last updated
09/27/2018
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