Provider Demographics
NPI:1134601610
Name:GOMKE, WILLIAM ARTHUR (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:GOMKE
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 1:142 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-8960
Mailing Address - Country:US
Mailing Address - Phone:540-931-7634
Mailing Address - Fax:
Practice Address - Street 1:132 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4733
Practice Address - Country:US
Practice Address - Phone:540-931-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health