Provider Demographics
NPI:1912084385
Name:SHADE, GAIL ARLENE (LPC)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:ARLENE
Last Name:SHADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-0903
Mailing Address - Country:US
Mailing Address - Phone:304-258-5353
Mailing Address - Fax:304-258-9313
Practice Address - Street 1:640 FAIRFAX ST
Practice Address - Street 2:SUITE #3
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1622
Practice Address - Country:US
Practice Address - Phone:304-258-5353
Practice Address - Fax:304-258-9313
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional