Healthcare Provider Details

I. General information

NPI: 1750995098
Provider Name (Legal Business Name): GWINN DENNIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MCLAWS CIR
WILLIAMSBURG VA
23185-5660
US

IV. Provider business mailing address

247 MCLAWS CIR
WILLIAMSBURG VA
23185-5660
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-0111
  • Fax:
Mailing address:
  • Phone: 757-253-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: