Healthcare Provider Details

I. General information

NPI: 1932357449
Provider Name (Legal Business Name): GILDA SEELKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 SOMMERVILLE CT SUITE 101
MIDLOTHIAN VA
23113-6813
US

IV. Provider business mailing address

14410 SOMMERVILLE CT SUITE 101
MIDLOTHIAN VA
23113-6813
US

V. Phone/Fax

Practice location:
  • Phone: 407-590-8492
  • Fax: 804-897-9359
Mailing address:
  • Phone: 407-590-8492
  • Fax: 804-897-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: