MEDICARE: GILLIAN ST. AMOUR RIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0709025506	VA
2	101YM0800X	Mental Health Counselor	0704017038	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0709025506	OTHER	VA	CSAC SUPERVISEE
2	0704017038	OTHER	VA	LICENSED RESIDENT IN COUNSELING

General Provider Information

NPI Number	:	1942030507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN ST. AMOUR RIC

Provider Business Mailing Address
First Line	:	1005 SOPHIA ST STE 200
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-3809
Country	:	US
Telephone Number	:	540-445-1803
Fax Number	:	540-318-1483

Provider Business Practice Location Address
First Line	:	1005 SOPHIA ST STE 200
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-3809
Country	:	US
Telephone Number	:	540-445-1803
Fax Number	:	540-318-1483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	10/22/2025

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Directions to “ GILLIAN ST. AMOUR RIC” Practice Location

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