Provider Demographics
NPI:1245495035
Name:VRTIAK, GALE ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:GALE
Middle Name:ELIZABETH
Last Name:VRTIAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 OLD BOND ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-4402
Mailing Address - Country:US
Mailing Address - Phone:804-739-8221
Mailing Address - Fax:
Practice Address - Street 1:681 HIOAKS RD
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4043
Practice Address - Country:US
Practice Address - Phone:804-320-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010246101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)