Provider Demographics
NPI:1093898470
Name:GIPSON, TESHANA DENISE (LCSW, CSOTP, EDD)
Entity Type:Individual
Prefix:
First Name:TESHANA
Middle Name:DENISE
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LCSW, CSOTP, EDD
Other - Prefix:
Other - First Name:TESHANA
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15808
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-5808
Mailing Address - Country:US
Mailing Address - Phone:804-308-1652
Mailing Address - Fax:804-308-1653
Practice Address - Street 1:4500 RICHMOND HENRICO TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-1346
Practice Address - Country:US
Practice Address - Phone:804-308-1652
Practice Address - Fax:804-308-1653
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040049171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904004917OtherLCSW