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Individual

AVERY GLENN GAUL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2215 LANGHORNE RD, LYNCHBURG, VA 24501-1121
(434) 477-5000
Mailing address
712 12TH ST APT 115, LYNCHBURG, VA 24504-3101
(704) 798-9696

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704017185
VA
101Y00000X
Counselor
A19761
NC

Other

Enumeration date
03/26/2025
Last updated
03/26/2025
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