Provider Demographics
NPI:1497513048
Name:GASTON, K DENISE (MA,, LPC)
Entity type:Individual
Prefix:MS
First Name:K
Middle Name:DENISE
Last Name:GASTON
Suffix:
Gender:F
Credentials:MA,, LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:645 GRISWOLD ST STE 1135
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-4105
Mailing Address - Country:US
Mailing Address - Phone:313-518-1408
Mailing Address - Fax:
Practice Address - Street 1:645 GRISWOLD
Practice Address - Street 2:11TH FLR PENOBSCOT BLDG, STE 1135
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4011
Practice Address - Country:US
Practice Address - Phone:313-224-8828
Practice Address - Fax:313-237-9299
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional