Provider Demographics
NPI:1295068203
Name:LINDSAY C. GIBSON, PSY.D. PLLC
Entity type:Organization
Organization Name:LINDSAY C. GIBSON, PSY.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-490-7811
Mailing Address - Street 1:1 COLUMBUS CTR STE 615
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6783
Mailing Address - Country:US
Mailing Address - Phone:757-490-7811
Mailing Address - Fax:757-436-6433
Practice Address - Street 1:1 COLUMBUS CTR STE 615
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6783
Practice Address - Country:US
Practice Address - Phone:757-490-7811
Practice Address - Fax:757-436-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001252103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty