Provider Demographics
NPI:1558651836
Name:GILL, KAREN REYNOLDS (LCSW, CT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:REYNOLDS
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSW, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2250
Mailing Address - Country:US
Mailing Address - Phone:804-909-0123
Mailing Address - Fax:
Practice Address - Street 1:2025 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7069
Practice Address - Country:US
Practice Address - Phone:804-909-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11526152OtherCAQH