| Corliss Gillespie, Llc | |
|
12531 Clipper Dr Woodbridge VA 22192-2355 | |
| (571) 402-2509 | |
| Not Available |
| Full Name | Corliss Gillespie, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 12531 Clipper Dr, Woodbridge, Virginia |
| Authorized Official Name and Position | Corliss Gillespie (CEO) |
| Authorized Official Contact | 5714022509 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Corliss Gillespie, Llc Po Box 4090 Woodbridge VA 22194-4090 Ph: () - | Corliss Gillespie, Llc 12531 Clipper Dr Woodbridge VA 22192-2355 Ph: (571) 402-2509 |
| NPI Number | 1912464140 |
|---|---|
| Provider Enumeration Date | 02/24/2019 |
| Last Update Date | 02/24/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912464140 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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