Provider Demographics
NPI:1023665593
Name:GASINK HAYWOOD, MEGAN ELAINE (LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELAINE
Last Name:GASINK HAYWOOD
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 1:5120 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2512
Mailing Address - Country:US
Mailing Address - Phone:540-797-7710
Mailing Address - Fax:
Practice Address - Street 1:3912 ELECTRIC RD BLDG C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4513
Practice Address - Country:US
Practice Address - Phone:540-776-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008328101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701008328OtherLPC LICENCSE #