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General NPI Number Information
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NPI Number | 1174427579
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Entity Type | Individual
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Provider Name | JUSTUS GICHABA
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Gender | Male
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 9211 FOREST HILL AVE STE 206
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City | RICHMOND
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State | VA
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Zip | 23235-6877
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Country | US
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Telephone | 678-371-2657
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Fax | 703-763-1763
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Provider Business Mailing Address
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Address Line | 15320 WITS END DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5889
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Country | US
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Telephone | 678-371-2657
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Fax | 703-763-1763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | NULL
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