Provider Demographics
NPI:1033258546
Name:IPSEN, VICKI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:IPSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9327 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4964
Mailing Address - Country:US
Mailing Address - Phone:804-658-3298
Mailing Address - Fax:804-912-2546
Practice Address - Street 1:9327 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4964
Practice Address - Country:US
Practice Address - Phone:804-658-3298
Practice Address - Fax:804-912-2546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040028911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical