Provider Demographics
NPI:1558529024
Name:EUBANKS, CHRISTINE GILMORE (PHD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:GILMORE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NORTH 11TH ST.
Mailing Address - Street 2:PO BOX 980150
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0150
Mailing Address - Country:US
Mailing Address - Phone:804-828-0431
Mailing Address - Fax:804-628-0950
Practice Address - Street 1:403 NORTH 11TH ST.
Practice Address - Street 2:NELSON CLINIC RM 304
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0150
Practice Address - Country:US
Practice Address - Phone:804-828-0431
Practice Address - Fax:804-628-0950
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1903231H00000X
VA2201001368231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA353796OtherANTHEM RICHMOND
VA353800OtherANTHEM NORTHERN VIRGINIA