Healthcare Provider Details

I. General information

NPI: 1679496137
Provider Name (Legal Business Name): RACHEL GLADSTONE LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SANTA ROSA RD RM 105
HENRICO VA
23229-5105
US

IV. Provider business mailing address

1503 SANTA ROSA RD RM 105
HENRICO VA
23229-5105
US

V. Phone/Fax

Practice location:
  • Phone: 917-817-7316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: