Provider Demographics
NPI:1497893507
Name:GOSNELL, BETTY S (MA, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:S
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-0386
Mailing Address - Country:US
Mailing Address - Phone:540-972-0504
Mailing Address - Fax:540-972-0500
Practice Address - Street 1:4448 GERMANNA HWY STE 7C
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2012
Practice Address - Country:US
Practice Address - Phone:540-972-0505
Practice Address - Fax:540-972-0500
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000081101YA0400X
VA0701002264101YP2500X
VA0717000708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist