Healthcare Provider Details

I. General information

NPI: 1568142784
Provider Name (Legal Business Name): LAUREN ASHLEY GIBBS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-5163
US

IV. Provider business mailing address

9533 THISTLETON CT
MECHANICSVILLE VA
23116-2892
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-6382
  • Fax:
Mailing address:
  • Phone: 804-690-9249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012674
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: