Provider Demographics
NPI:1083094536
Name:CLISSOLD, GILLIAN (LPC)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:CLISSOLD
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 1:11804 COLVIN LN
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-2346
Mailing Address - Country:US
Mailing Address - Phone:703-675-5361
Mailing Address - Fax:
Practice Address - Street 1:11804 COLVIN LN
Practice Address - Street 2:
Practice Address - City:NOKESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20181-2346
Practice Address - Country:US
Practice Address - Phone:703-675-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-30
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional