Provider Demographics
NPI:1871635904
Name:GILL, STACY HAMILTON (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:HAMILTON
Last Name:GILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 PARVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7470
Mailing Address - Country:US
Mailing Address - Phone:804-516-5137
Mailing Address - Fax:
Practice Address - Street 1:412 LIBBIE AVE STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2658
Practice Address - Country:US
Practice Address - Phone:804-516-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040018531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA263152-000OtherMAGELLAN
VAO85712OtherOPTIMA
VA110313OtherANTHEM
VA2169350OtherMAMSI
VAO85712OtherOPTIMA