Provider Demographics
NPI:1497053946
Name:BOHN, GWENDOLYN LIGH (MT, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LIGH
Last Name:BOHN
Suffix:
Gender:F
Credentials:MT, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 FLOUR MILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4265
Mailing Address - Country:US
Mailing Address - Phone:804-305-7091
Mailing Address - Fax:
Practice Address - Street 1:1480 OAK BRIDGE CT
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-8054
Practice Address - Country:US
Practice Address - Phone:804-423-1389
Practice Address - Fax:804-423-1393
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical