Healthcare Provider Details

I. General information

NPI: 1598613184
Provider Name (Legal Business Name): LAURA GAYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HICKMAN RD STE 104
CHARLOTTESVILLE VA
22911-3572
US

IV. Provider business mailing address

1013 LINDEN AVE APT W
CHARLOTTESVILLE VA
22902-9022
US

V. Phone/Fax

Practice location:
  • Phone: 434-207-2915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704018933
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: