Provider Demographics
NPI:1164181962
Name:STACY H. GILL, LLC
Entity Type:Organization
Organization Name:STACY H. GILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-516-5137
Mailing Address - Street 1:2728 PARVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7470
Mailing Address - Country:US
Mailing Address - Phone:804-516-5137
Mailing Address - Fax:
Practice Address - Street 1:2405 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4448
Practice Address - Country:US
Practice Address - Phone:804-516-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health