Provider Demographics
NPI:1780101261
Name:BREEDEN, GAYLE MARIE
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:MARIE
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:MARIE
Other - Last Name:GLASMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:44790 MAYNARD SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44790 MAYNARD SQUARE, SUITE 130
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6514
Practice Address - Country:US
Practice Address - Phone:703-542-3737
Practice Address - Fax:703-584-7378
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical