Gwendolyn Renee Drake, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

0810004452 Issued in VA

Practice address

650 Joel Dr
Fort Campbell, KY 42223-5318

Phone

(757) 395-0842

NPI assigned

Apr 2, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Center for Personal Growth & Change

  • Mental Health Counselor
  • Norfolk, VA
  • NPI 1053450817
  NPD (past)
• Chapman Senior Care, Inc.

  • Clinical Social Worker
  • Richmond, VA
  • NPI 1669439691
  NPD (past)
• Comprehensive Psychological Services

  • Professional Counselor
  • Chesapeake, VA
  • NPI 1598861387
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1871859066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 GREEN ST APT 4E",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042470",
            "telephone_number": "757-395-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "757-395-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "GWENDOLYN",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-02",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810004452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julian Macon Dismukes III, DMD
• Suzyn Mary Douglass-Everhard, M.A.
• Thomas Peter Dove, MD
• Peter Michael Doyle, DPT
• Jordan Draheim
• Nicholas Demetrios Paul Drakos, MD
• Moriah Dreher
• Erin Driver, PA-C
• Peter Ryan Drumgoole, 18D
• Charles E Drury, PA

• Psychologist in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.