Provider Demographics
NPI:1033666409
Name:ADELIA GREGOIRE LLC
Entity Type:Organization
Organization Name:ADELIA GREGOIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELIA
Authorized Official - Middle Name:FURR
Authorized Official - Last Name:GREGOIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-423-1266
Mailing Address - Street 1:6126 STUDELEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1032
Mailing Address - Country:US
Mailing Address - Phone:757-423-1266
Mailing Address - Fax:
Practice Address - Street 1:6126 STUDELEY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1032
Practice Address - Country:US
Practice Address - Phone:757-423-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081000263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty