Provider Demographics
NPI:1811788417
Name:GARY, VAREKA TAVION
Entity type:Individual
Prefix:
First Name:VAREKA
Middle Name:TAVION
Last Name:GARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 BLACK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-3627
Mailing Address - Country:US
Mailing Address - Phone:757-692-4247
Mailing Address - Fax:
Practice Address - Street 1:18444 BLACK CREEK RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-3627
Practice Address - Country:US
Practice Address - Phone:757-692-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health