Provider Demographics
NPI:1154068971
Name:GAMBLE, DAVID M (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14107 OLD FORT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3948
Mailing Address - Country:US
Mailing Address - Phone:804-300-8222
Mailing Address - Fax:
Practice Address - Street 1:14107 OLD FORT DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-3948
Practice Address - Country:US
Practice Address - Phone:804-300-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional