Provider Demographics
NPI:1376663385
Name:REASON, GERALD EDWARD JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:EDWARD
Last Name:REASON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 CORPORATION LN
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3162
Mailing Address - Country:US
Mailing Address - Phone:757-687-6334
Mailing Address - Fax:
Practice Address - Street 1:4417 CORPORATION LN
Practice Address - Street 2:SUITE 250
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3162
Practice Address - Country:US
Practice Address - Phone:757-687-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO801438OtherEAP PROVIDER NUMBER
VAO802641MOtherSENTARA PROVIDER NUMBER
VA196627OtherANTHEM PROVIDER NUMBER