Provider Demographics
NPI:1588977078
Name:NEWSOME, GAIL MATIJCZYK
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:MATIJCZYK
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:ELLEN
Other - Last Name:MATIJCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:237 HAVILAND RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4715
Mailing Address - Country:US
Mailing Address - Phone:757-549-1436
Mailing Address - Fax:
Practice Address - Street 1:860 GREENBRIER CIR
Practice Address - Street 2:STE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2640
Practice Address - Country:US
Practice Address - Phone:757-547-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040015341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical