| Doctor Name: | CONNIE C GARDNER |
| NPI Number: | 1659531028 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 0701004280 |
| Business Practice Address: | 350 Doodle Ln Tappahannock, VA - 225606249 |
| Business Phone Number: | 8044458020 |
| Business Fax Number: | |
| Mailing Address: | 218 Maple Valley Rd, TAPPAHANNOCK |
| State: | VA |
| Postal Code: | 225605662 |
| Phone Number: | 8044458020 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2008 |
| NPI Last Update Date: | 02/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0701004280 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |