Provider Demographics
NPI:1538312160
Name:GAMBLE, KIMBERLY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1149
Mailing Address - Country:US
Mailing Address - Phone:757-228-5635
Mailing Address - Fax:757-233-0327
Practice Address - Street 1:522 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1149
Practice Address - Country:US
Practice Address - Phone:757-228-5635
Practice Address - Fax:757-233-0327
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist