Provider Demographics
NPI:1437266764
Name:BEDNARSKI-GIBBS, KRISTA LYNN (LCSW PLC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LYNN
Last Name:BEDNARSKI-GIBBS
Suffix:
Gender:F
Credentials:LCSW PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BROOKNEIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602
Mailing Address - Country:US
Mailing Address - Phone:540-550-5044
Mailing Address - Fax:540-667-2941
Practice Address - Street 1:110 LAUCK DRIVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603
Practice Address - Country:US
Practice Address - Phone:540-667-7830
Practice Address - Fax:540-667-2941
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182020OtherBCBS
VA00W922K01Medicare PIN