Provider Demographics
NPI:1225110182
Name:CRUTCHFIELD, GAYLE M (LCSW)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:M
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 BILLINGSGATE CIR STE D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4242
Mailing Address - Country:US
Mailing Address - Phone:804-750-2105
Mailing Address - Fax:804-750-2179
Practice Address - Street 1:1891 BILLINGSGATE CIR STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4242
Practice Address - Country:US
Practice Address - Phone:804-750-2105
Practice Address - Fax:804-750-2179
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040017721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA89-0684-0Medicaid