Provider Demographics
NPI:1598920720
Name:GILSTRAP, BETHANY DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:DAWN
Last Name:GILSTRAP
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 1:600 GRESHAM DR
Mailing Address - Street 2:STE 8630C
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6105
Mailing Address - Fax:757-388-6106
Practice Address - Street 1:301 RIVERVIEW AVE STE 202A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9015
Practice Address - Fax:757-510-9041
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003971103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical