Healthcare Provider Details

I. General information

NPI: 1831440544
Provider Name (Legal Business Name): KENYUATIA LYNN GASH LCSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 WYTHE CREEK RD STE C
POQUOSON VA
23662-1975
US

IV. Provider business mailing address

10 COLISEUM CROSSING STE 5142
HAMPTON VA
23666-0966
US

V. Phone/Fax

Practice location:
  • Phone: 757-868-0072
  • Fax:
Mailing address:
  • Phone: 757-344-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018484
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: