Provider Demographics
NPI:1972249621
Name:GILL, CARRIE GAGER (LPC, LBS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:GAGER
Last Name:GILL
Suffix:
Gender:F
Credentials:LPC, LBS
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:GAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:519 STOCKPORT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE COMO
Mailing Address - State:PA
Mailing Address - Zip Code:18437-1028
Mailing Address - Country:US
Mailing Address - Phone:570-470-5730
Mailing Address - Fax:
Practice Address - Street 1:100 4TH ST STE 13
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1869
Practice Address - Country:US
Practice Address - Phone:570-253-6913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional