Provider Demographics
NPI:1891053344
Name:GATEWAY COUNSELING CENTER
Entity Type:Organization
Organization Name:GATEWAY COUNSELING CENTER
Other - Org Name:GATEWAY YOUTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DR/LPC
Authorized Official - Phone:703-309-9852
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555
Mailing Address - Country:US
Mailing Address - Phone:703-309-9852
Mailing Address - Fax:
Practice Address - Street 1:400 HOPE ROAD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:703-309-9852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children