Provider Demographics
NPI:1053421362
Name:PERRY, GISELLE (LPC)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-3641
Mailing Address - Country:US
Mailing Address - Phone:304-535-6343
Mailing Address - Fax:
Practice Address - Street 1:171 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-3641
Practice Address - Country:US
Practice Address - Phone:304-535-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004030101YP2500X
WV2125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1053421362Medicaid