Provider Demographics
NPI:1871770644
Name:MEARS, GAIL (LADC)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:MEARS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4839
Mailing Address - Country:US
Mailing Address - Phone:802-793-8426
Mailing Address - Fax:
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4839
Practice Address - Country:US
Practice Address - Phone:802-793-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
079-58537OtherBLUE CROSS
VT1100008Medicaid