Provider Demographics
NPI:1164092789
Name:GUMMELT, VIRGINIA (GINGER) SILLOWAY (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA (GINGER)
Middle Name:SILLOWAY
Last Name:GUMMELT
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 INFINITY LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3415
Mailing Address - Country:US
Mailing Address - Phone:409-790-3337
Mailing Address - Fax:
Practice Address - Street 1:1535 INFINITY LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3415
Practice Address - Country:US
Practice Address - Phone:409-790-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical