Provider Demographics
NPI:1346092277
Name:GIBBONS, AALIYAH S (PSYD)
Entity Type:Individual
Prefix:
First Name:AALIYAH
Middle Name:S
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 NEABSCO COMMON PL APT 547
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6720
Mailing Address - Country:US
Mailing Address - Phone:609-851-1823
Mailing Address - Fax:
Practice Address - Street 1:2701 NEABSCO COMMON PL APT 547
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6720
Practice Address - Country:US
Practice Address - Phone:609-851-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical