Provider Demographics
NPI:1417161878
Name:ROSS, BETTINA GUYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:GUYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TIMBERLINE CRES
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3901
Mailing Address - Country:US
Mailing Address - Phone:757-989-5109
Mailing Address - Fax:
Practice Address - Street 1:225 28TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-3907
Practice Address - Country:US
Practice Address - Phone:757-592-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical