Provider Demographics
NPI:1376730655
Name:GIL-RIVAS, VIRGINIA (PHD)
Entity Type:Individual
Prefix:PROF
First Name:VIRGINIA
Middle Name:
Last Name:GIL-RIVAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:GIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:5111 SUNBURST LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4246
Mailing Address - Country:US
Mailing Address - Phone:704-687-4747
Mailing Address - Fax:704-687-3096
Practice Address - Street 1:9201 UNIVERSITY CITY BLVD
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28223-0001
Practice Address - Country:US
Practice Address - Phone:704-687-4747
Practice Address - Fax:704-687-3096
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist