Provider Demographics
NPI:1417004565
Name:RAFALA, GARY T (LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:T
Last Name:RAFALA
Suffix:
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 1:700 SOUTHRIDGE PARKWAY
Mailing Address - Street 2:SUITE 301B
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701
Mailing Address - Country:US
Mailing Address - Phone:540-829-0036
Mailing Address - Fax:540-829-6452
Practice Address - Street 1:700 SOUTHRIDGE PARKWAY
Practice Address - Street 2:SUITE 301B
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701
Practice Address - Country:US
Practice Address - Phone:540-829-0036
Practice Address - Fax:540-829-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49857101Y00000X
VA0701002217101YP2500X
VA0717000260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA333253OtherANTHEM
VA0701002217OtherVA LPC