Healthcare Provider Details

I. General information

NPI: 1174427579
Provider Name (Legal Business Name): JUSTUS GICHABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 FOREST HILL AVE STE 206
RICHMOND VA
23235-6877
US

IV. Provider business mailing address

15320 WITS END DR
WOODBRIDGE VA
22193-5889
US

V. Phone/Fax

Practice location:
  • Phone: 678-371-2657
  • Fax: 703-763-1763
Mailing address:
  • Phone: 678-371-2657
  • Fax: 703-763-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: