Provider Demographics
NPI:1285933523
Name:GASTON, HAROLD DOUGLAS SR (MA, LLPC, CADC)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:DOUGLAS
Last Name:GASTON
Suffix:SR
Gender:M
Credentials:MA, LLPC, CADC
Other - Prefix:MR
Other - First Name:H.
Other - Middle Name:DOUGLAS
Other - Last Name:GASTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:308 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-0000
Mailing Address - Country:US
Mailing Address - Phone:734-646-6144
Mailing Address - Fax:
Practice Address - Street 1:14930 LAPLAISANCE, SUITE 106 (HARWOOD PLAZA)
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-646-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00765101YA0400X
MIL1690084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)