| Gail A. Shade, M.a., Llc | |
|
640 Fairfax St Suite #3 Berkeley Springs WV 25411-1622 | |
| (304) 258-5353 | |
| (304) 258-9313 |
| Full Name | Gail A. Shade, M.a., Llc |
|---|---|
| Speciality | Counselor |
| Location | 640 Fairfax St, Berkeley Springs, West Virginia |
| Authorized Official Name and Position | Gail Arlene Shade (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 3042585353 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gail A. Shade, M.a., Llc Po Box 903 Berkeley Springs WV 25411-0903 Ph: (304) 258-5353 | Gail A. Shade, M.a., Llc 640 Fairfax St Suite #3 Berkeley Springs WV 25411-1622 Ph: (304) 258-5353 |
| NPI Number | 1609932623 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1759825144 |
|---|---|
| Medicare Enrollment ID | O20240626002729 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609932623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1001 (West Virginia) | Primary |
| Provider Name | Gail Arlene Shade |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912084385 PECOS PAC ID: 2668916057 Enrollment ID: I20240626002996 |
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