MEDICARE: MARY GIENCKE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701006852	VA

General Provider Information

NPI Number	:	1366986259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GIENCKE LPC

Provider Business Mailing Address
First Line	:	2202 EXECUTIVE DR STE C
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6604
Country	:	US
Telephone Number	:	757-827-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	638 INDEPENDENCE PKWY STE 240
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-5222
Country	:	US
Telephone Number	:	757-965-5886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	03/20/2025

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