Healthcare Provider Details

I. General information

NPI: 1023547528
Provider Name (Legal Business Name): GINA ELYSIA WURFEL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA E SUSLICK

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 STONY POINT PKWY STE 350
RICHMOND VA
23235-1945
US

IV. Provider business mailing address

1800 GLENSIDE DR. SUITE 104
RICHMOND VA
23226
US

V. Phone/Fax

Practice location:
  • Phone: 952-202-9755
  • Fax: 844-541-1162
Mailing address:
  • Phone: 804-288-0399
  • Fax: 804-673-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903002538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: