Healthcare Provider Details

I. General information

NPI: 1225110182
Provider Name (Legal Business Name): GAYLE M CRUTCHFIELD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 BILLINGSGATE CIR STE D
RICHMOND VA
23238-4242
US

IV. Provider business mailing address

1891 BILLINGSGATE CIR STE D
RICHMOND VA
23238-4242
US

V. Phone/Fax

Practice location:
  • Phone: 804-750-2105
  • Fax: 804-750-2179
Mailing address:
  • Phone: 804-750-2105
  • Fax: 804-750-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: