MEDICARE: LINDSAY C. GIBSON, PSY.D. PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810001252	VA

General Provider Information

NPI Number	:	1295068203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDSAY C. GIBSON, PSY.D. PLLC

Provider Business Mailing Address
First Line	:	1 COLUMBUS CTR STE 615
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6783
Country	:	US
Telephone Number	:	757-490-7811
Fax Number	:	757-436-6433

Provider Business Practice Location Address
First Line	:	1 COLUMBUS CTR STE 615
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6783
Country	:	US
Telephone Number	:	757-490-7811
Fax Number	:	757-436-6433

Authorized Official
Title or Position	:	MEMBER
Name	:	LINDSAY CARTER GIBSON
Credential	:	PSYD
Telephone Number	:	757-490-7811

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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