Provider Demographics
NPI:1942808845
Name:GEARHEART, TODD ALAN
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALAN
Last Name:GEARHEART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GOOSE CREEK TER
Mailing Address - Street 2:
Mailing Address - City:THAXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24174-3010
Mailing Address - Country:US
Mailing Address - Phone:540-397-1053
Mailing Address - Fax:
Practice Address - Street 1:102 GOOSE CREEK TER
Practice Address - Street 2:
Practice Address - City:THAXTON
Practice Address - State:VA
Practice Address - Zip Code:24174-3010
Practice Address - Country:US
Practice Address - Phone:540-397-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704009932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional