Provider Demographics
NPI:1972364131
Name:GREEN GATES COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:GREEN GATES COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-485-9349
Mailing Address - Street 1:4335 SUNRAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2625
Mailing Address - Country:US
Mailing Address - Phone:757-485-9349
Mailing Address - Fax:757-465-3639
Practice Address - Street 1:4335 SUNRAY AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2625
Practice Address - Country:US
Practice Address - Phone:757-485-9349
Practice Address - Fax:757-465-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty