Provider Demographics
NPI:1508187881
Name:GUDOR, KINGA (MSW, LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:KINGA
Middle Name:
Last Name:GUDOR
Suffix:
Gender:F
Credentials:MSW, LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 ROCKBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1418
Mailing Address - Country:US
Mailing Address - Phone:757-319-5416
Mailing Address - Fax:757-918-8760
Practice Address - Street 1:129 W VIRGINIA BEACH BLVD STE 204A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2030
Practice Address - Country:US
Practice Address - Phone:757-319-5416
Practice Address - Fax:757-918-8760
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508187881Medicaid
Q46604AMedicare UPIN