MEDICARE: ANN LOUISE GILPIN MA, CAADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		MI
3	101YM0800X	Mental Health Counselor
4	101YM0800X	Mental Health Counselor		MI
5	104100000X	Social Worker	MSW010649	GA

General Provider Information

NPI Number	:	1467880450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN LOUISE GILPIN MA, CAADC

Provider Business Mailing Address
First Line	:	677 E. MAIN ST.
Second Line	:	STE. A
City	:	CENTREVILLE
State	:	MI
Zip	:	49032
Country	:	US
Telephone Number	:	269-467-1001
Fax Number	:	269-467-3075

Provider Business Practice Location Address
First Line	:	111 N PATTERSON ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-5515
Country	:	US
Telephone Number	:	229-219-1831
Fax Number	:	229-219-2832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	05/09/2022

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