Healthcare Provider Details

I. General information

NPI: 1275073975
Provider Name (Legal Business Name): GRETCHEN (GRETEL) DEPILLIS CHRISTIAN COUNSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18100 SHADY SIDE LN
RIVERSIDE CA
92504-9733
US

IV. Provider business mailing address

18100 SHADY SIDE LN
RIVERSIDE CA
92504-9733
US

V. Phone/Fax

Practice location:
  • Phone: 951-789-0978
  • Fax:
Mailing address:
  • Phone: 312-622-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: