Healthcare Provider Details

I. General information

NPI: 1619635190
Provider Name (Legal Business Name): ANNE KENDALL GILES M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 24
GUM SPRING VA
23065-0024
US

IV. Provider business mailing address

PO BOX 24
GUM SPRING VA
23065-0024
US

V. Phone/Fax

Practice location:
  • Phone: 804-477-4993
  • Fax:
Mailing address:
  • Phone: 804-477-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: