Provider Demographics
NPI:1366462970
Name:LUPTON, GARY (LPC, LMFT, LSATP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:LUPTON
Suffix:
Gender:M
Credentials:LPC, LMFT, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GOOSE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-8430
Mailing Address - Country:US
Mailing Address - Phone:703-627-0225
Mailing Address - Fax:703-657-1999
Practice Address - Street 1:385 GARRISONVILLE RD.
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-657-1228
Practice Address - Fax:540-657-1999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000355106H00000X
VA0718000106101YA0400X
VA0701002601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-0645-5Medicaid