Provider Demographics
NPI:1982018354
Name:GOSTEL, KEITH TERENCE (LCSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:TERENCE
Last Name:GOSTEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1577
Mailing Address - Country:US
Mailing Address - Phone:804-932-8170
Mailing Address - Fax:804-520-8007
Practice Address - Street 1:3601 LOCUST CT
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1577
Practice Address - Country:US
Practice Address - Phone:804-932-8170
Practice Address - Fax:804-520-8007
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical