Provider Demographics
NPI:1457639221
Name:GAMBRELL, CRISTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRISTA
Middle Name:
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 WEBB CTR
Mailing Address - Street 2:OLD DOMINION UNIVERSITY
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23529-0001
Mailing Address - Country:US
Mailing Address - Phone:757-683-4401
Mailing Address - Fax:757-683-3565
Practice Address - Street 1:1526 WEBB CTR
Practice Address - Street 2:OLD DOMINION UNIVERSITY
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23529-0001
Practice Address - Country:US
Practice Address - Phone:757-683-4401
Practice Address - Fax:757-683-3565
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA# 0701005513101YP2500X
OHE.1100042101YP2500X
NC8419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional