Provider Demographics
NPI:1154016400
Name:MAZURKIEWICZ, GIBSON E (LPC)
Entity type:Individual
Prefix:MR
First Name:GIBSON
Middle Name:E
Last Name:MAZURKIEWICZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SOUTH KING ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:571-224-7954
Mailing Address - Fax:703-485-3559
Practice Address - Street 1:602 SOUTH KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:571-224-7954
Practice Address - Fax:703-485-3559
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty