Provider Demographics
NPI:1568672178
Name:GUPTA, LINDA AYSCUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:AYSCUE
Last Name:GUPTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 842027
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23284-2027
Mailing Address - Country:US
Mailing Address - Phone:804-828-3405
Mailing Address - Fax:
Practice Address - Street 1:1001 W. FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-2027
Practice Address - Country:US
Practice Address - Phone:804-828-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040008121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical