Provider Demographics
NPI:1588961445
Name:GATUNDU, VIRGINIA WAITHIRA (LPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:WAITHIRA
Last Name:GATUNDU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 E FLORIAN AVE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2797
Mailing Address - Country:US
Mailing Address - Phone:480-969-3800
Mailing Address - Fax:480-222-3221
Practice Address - Street 1:924 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4108
Practice Address - Country:US
Practice Address - Phone:480-969-3800
Practice Address - Fax:480-222-3221
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional