Healthcare Provider Details

I. General information

NPI: 1730911322
Provider Name (Legal Business Name): MIRANDA JEANNE GATHRIGHT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BREMO RD STE 101
RICHMOND VA
23226-2438
US

IV. Provider business mailing address

6808 CLUCK LN
RICHMOND VA
23231-6660
US

V. Phone/Fax

Practice location:
  • Phone: 804-848-8737
  • Fax:
Mailing address:
  • Phone: 703-915-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0704018036
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: