Healthcare Provider Details

I. General information

NPI: 1215698147
Provider Name (Legal Business Name): RASHELL GAMBLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 DISCOVERY PARK BLVD STE 201
WILLIAMSBURG VA
23188-2860
US

IV. Provider business mailing address

3908 CROMWELL LN
WILLIAMSBURG VA
23188-2661
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 752-952-2654
Mailing address:
  • Phone: 757-870-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013018
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: