Healthcare Provider Details

I. General information

NPI: 1053340224
Provider Name (Legal Business Name): DAVID T TIPP LCSW, LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 HULL STREET RD SUITE C4
N. CHESTERFIELD VA
23236-1246
US

IV. Provider business mailing address

9413 HULL STREET ROAD SUITE C4
N. CHESTERFIELD VA
23236
US

V. Phone/Fax

Practice location:
  • Phone: 804-339-7553
  • Fax: 804-745-4742
Mailing address:
  • Phone: 804-339-7553
  • Fax: 804-745-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number09040000857
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: