Provider Demographics
NPI:1053340224
Name:TIPP, DAVID T (LCSW, LLC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:TIPP
Suffix:
Gender:M
Credentials:LCSW, LLC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9413 HULL STREET ROAD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:N. CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236
Mailing Address - Country:US
Mailing Address - Phone:804-339-7553
Mailing Address - Fax:804-745-4742
Practice Address - Street 1:9413 HULL STREET RD
Practice Address - Street 2:SUITE C4
Practice Address - City:N. CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1246
Practice Address - Country:US
Practice Address - Phone:804-339-7553
Practice Address - Fax:804-745-4742
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA09040000857104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008952485Medicaid
VA008952485Medicaid