Healthcare Provider Details

I. General information

NPI: 1801878871
Provider Name (Legal Business Name): LINDSAY C GIBSON PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLUMBUS CTR STE 615
VIRGINIA BEACH VA
23462-6722
US

IV. Provider business mailing address

1 COLUMBUS CTR STE 615
VIRGINIA BEACH VA
23462-6722
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-7811
  • Fax: 757-436-6433
Mailing address:
  • Phone: 757-490-7811
  • Fax: 757-436-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001252
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: