Provider Demographics
NPI:1912223124
Name:GAINES, JEANETTE (LPC)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:GAINES
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 1:1131 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5545
Mailing Address - Country:US
Mailing Address - Phone:757-278-9823
Mailing Address - Fax:
Practice Address - Street 1:1131 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5545
Practice Address - Country:US
Practice Address - Phone:757-278-9823
Practice Address - Fax:844-633-2088
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005123101YP2500X
VA0701005533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional