Provider Demographics
NPI:1275501256
Name:GAY, WILLIS H (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIS
Middle Name:H
Last Name:GAY
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HANSON AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3126
Mailing Address - Country:US
Mailing Address - Phone:540-361-4330
Mailing Address - Fax:540-361-4331
Practice Address - Street 1:305 HANSON AVE
Practice Address - Street 2:SUITE170
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3126
Practice Address - Country:US
Practice Address - Phone:540-361-4330
Practice Address - Fax:540-361-4331
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001766101YP2500X
VA0717000031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional