Healthcare Provider Details

I. General information

NPI: 1730586470
Provider Name (Legal Business Name): GINA JUSTICE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 2ND AVE STE 1
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

PO BOX 2080
WILLIAMSON WV
25661-2080
US

V. Phone/Fax

Practice location:
  • Phone: 304-236-5902
  • Fax: 855-487-4047
Mailing address:
  • Phone: 304-236-5902
  • Fax: 304-909-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00944247
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: