Healthcare Provider Details

I. General information

NPI: 1467645804
Provider Name (Legal Business Name): SHERMAN W. GIFFORD L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 RADFORD AVE SUITE #106
RICHMOND VA
23230-3539
US

IV. Provider business mailing address

4807 RADFORD AVE SUITE #106
RICHMOND VA
23230-3539
US

V. Phone/Fax

Practice location:
  • Phone: 804-278-9151
  • Fax: 804-278-9221
Mailing address:
  • Phone: 804-278-9151
  • Fax: 804-278-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: