Provider Demographics
NPI:1710162946
Name:GIMBLETT, WILLIAM EUGENE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:GIMBLETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SECOND ST
Mailing Address - Street 2:#301
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1499
Mailing Address - Country:US
Mailing Address - Phone:703-727-0611
Mailing Address - Fax:
Practice Address - Street 1:805 CAMERON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1499
Practice Address - Country:US
Practice Address - Phone:703-727-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040002411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical