Doctor Name: | MRS. GAIL ARLENE SHADE |
NPI Number: | 1912084385 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 1001 |
Business Practice Address: | 640 Fairfax St Suite #3 Berkeley Springs, WV - 254111622 |
Business Phone Number: | 3042585353 |
Business Fax Number: | 3042589313 |
Mailing Address: | Po Box 903, BERKELEY SPRINGS |
State: | WV |
Postal Code: | 254110903 |
Phone Number: | 3042585353 |
Fax Number: | 3042589313 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |