Healthcare Provider Details

I. General information

NPI: 1912127226
Provider Name (Legal Business Name): GRETCHEN ELIZABETH WILHELM PHD, LPC, LSATP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN ELIZABETH SQUIRES

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N. CENTRAL AVE
STAUNTON VA
24401
US

IV. Provider business mailing address

2 N. CENTRAL AVE
STAUNTON VA
24401
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-7045
  • Fax: 540-949-8897
Mailing address:
  • Phone: 540-949-7045
  • Fax: 540-949-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number011159
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC 0008035
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: