Provider Demographics
NPI:1629195482
Name:WILLEN, GAIL SUSAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:SUSAN
Last Name:WILLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 DEER CROSS TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0328
Mailing Address - Country:US
Mailing Address - Phone:704-763-2993
Mailing Address - Fax:
Practice Address - Street 1:4815 DEER CROSS TRL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0328
Practice Address - Country:US
Practice Address - Phone:704-763-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health