Provider Demographics
NPI:1811310261
Name:D THOMAS TIPP LCSW
Entity type:Organization
Organization Name:D THOMAS TIPP LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TIPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-339-7553
Mailing Address - Street 1:9511 HULL STREET RD STE B1
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2600
Mailing Address - Country:US
Mailing Address - Phone:804-339-7553
Mailing Address - Fax:804-745-4742
Practice Address - Street 1:9511 HULL STREET ROAD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3407
Practice Address - Country:US
Practice Address - Phone:804-339-7553
Practice Address - Fax:804-745-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty