Provider Demographics
NPI:1043420995
Name:GILLIS, BETH ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-2155
Mailing Address - Country:US
Mailing Address - Phone:434-476-2379
Mailing Address - Fax:434-575-1063
Practice Address - Street 1:585 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558-2155
Practice Address - Country:US
Practice Address - Phone:434-476-2379
Practice Address - Fax:434-575-1063
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003866101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor