Provider Demographics
NPI:1356825293
Name:GARDNER COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GARDNER COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-390-3512
Mailing Address - Street 1:218 MAPLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-5662
Mailing Address - Country:US
Mailing Address - Phone:434-390-3512
Mailing Address - Fax:804-442-7081
Practice Address - Street 1:218 MAPLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-5662
Practice Address - Country:US
Practice Address - Phone:434-390-3512
Practice Address - Fax:804-442-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)