Healthcare Provider Details

I. General information

NPI: 1366462970
Provider Name (Legal Business Name): GARY LUPTON LPC, LMFT, LSATP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 GARRISONVILLE RD.
STAFFORD VA
22554
US

IV. Provider business mailing address

11 GOOSE CREEK CIR
FREDERICKSBURG VA
22406-8430
US

V. Phone/Fax

Practice location:
  • Phone: 540-657-1228
  • Fax: 540-657-1999
Mailing address:
  • Phone: 703-627-0225
  • Fax: 703-657-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000106
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002601
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000355
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: