Provider Demographics
NPI:1316013279
Name:GRIGSBY, DELORES (LCSW)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109-B NORTH KING STREET NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-771-1773
Mailing Address - Fax:703-777-4552
Practice Address - Street 1:206 BIRCH ST NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4524
Practice Address - Country:US
Practice Address - Phone:703-771-1773
Practice Address - Fax:703-771-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical