Provider Demographics
NPI:1245039882
Name:LIPP, IMANI CHANEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:IMANI
Middle Name:CHANEL
Last Name:LIPP
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 1:1210 PROGRESSIVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2849
Mailing Address - Country:US
Mailing Address - Phone:757-386-4578
Mailing Address - Fax:
Practice Address - Street 1:1210 PROGRESSIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2849
Practice Address - Country:US
Practice Address - Phone:757-386-4578
Practice Address - Fax:757-386-4604
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical