Individual
DR. CONNIE C GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LSATP
Contact information
Practice address
218 MAPLE VALLEY RD, TAPPAHANNOCK, VA 22560-5662
(434) 390-3512
(804) 442-7081
Mailing address
218 MAPLE VALLEY RD, TAPPAHANNOCK, VA 22560-5662
(804) 445-8020
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
2665
VA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0701004280
VA
Other
Enumeration date
06/10/2008
Last updated
07/30/2024
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