Provider Demographics
NPI:1437951811
Name:GAUL, AVERY GLENN
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:GLENN
Last Name:GAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 12TH ST APT 115
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-3101
Mailing Address - Country:US
Mailing Address - Phone:704-798-9696
Mailing Address - Fax:
Practice Address - Street 1:2215 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1121
Practice Address - Country:US
Practice Address - Phone:434-477-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19761101Y00000X
VA0704017185101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor