Provider Demographics
NPI:1083222962
Name:GRICOL, LOUISE (MA, CTRS)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:GRICOL
Suffix:
Gender:F
Credentials:MA, CTRS
Other - Prefix:MRS
Other - First Name:LOUISE
Other - Middle Name:ROBIN
Other - Last Name:GRICOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CTRS
Mailing Address - Street 1:13865 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5728
Mailing Address - Country:US
Mailing Address - Phone:757-328-1594
Mailing Address - Fax:
Practice Address - Street 1:13865 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-5728
Practice Address - Country:US
Practice Address - Phone:757-328-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst