Provider Demographics
NPI:1861574972
Name:AUSTIN, GAIL J (LCSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:J
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 W. PRINCESS ANNE ROAD
Mailing Address - Street 2:# A4
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-627-1183
Mailing Address - Fax:
Practice Address - Street 1:327 W 21ST ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2130
Practice Address - Country:US
Practice Address - Phone:757-622-9852
Practice Address - Fax:757-622-4033
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008918T80Medicare ID - Type Unspecified