Provider Demographics
NPI:1942030507
Name:ST. AMOUR, GILLIAN (LRIC)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:ST. AMOUR
Suffix:
Gender:F
Credentials:LRIC
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:
Other - Last Name:HORDUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 SOPHIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3809
Mailing Address - Country:US
Mailing Address - Phone:540-445-1803
Mailing Address - Fax:540-318-1483
Practice Address - Street 1:1005 SOPHIA ST STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3809
Practice Address - Country:US
Practice Address - Phone:540-445-1803
Practice Address - Fax:540-318-1483
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709025506101YA0400X
VA0704017038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0709025506OtherCSAC SUPERVISEE
VA0704017038OtherLICENSED RESIDENT IN COUNSELING