Provider Demographics
NPI:1427386929
Name:GAINESVILLE PROFESSIONAL COUNSELING CENTER
Entity Type:Organization
Organization Name:GAINESVILLE PROFESSIONAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEYERL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:571-261-1921
Mailing Address - Street 1:7450 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3090
Mailing Address - Country:US
Mailing Address - Phone:571-261-1921
Mailing Address - Fax:571-261-1170
Practice Address - Street 1:7450 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3090
Practice Address - Country:US
Practice Address - Phone:571-261-1921
Practice Address - Fax:571-261-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty