Provider Demographics
NPI:1407365943
Name:GIFT OF THERAPY AND CONSULTING, LLC
Entity Type:Organization
Organization Name:GIFT OF THERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ACS
Authorized Official - Phone:757-419-1871
Mailing Address - Street 1:4240 PORTSMOUTH BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2129
Mailing Address - Country:US
Mailing Address - Phone:757-419-1871
Mailing Address - Fax:757-419-1871
Practice Address - Street 1:317 OFFICE SQUARE LN STE B102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3650
Practice Address - Country:US
Practice Address - Phone:757-419-1871
Practice Address - Fax:757-419-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005610251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700213766Medicaid