Provider Demographics
NPI:1407498785
Name:GRUBB, JACQUELINE E (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 SUNRAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2625
Mailing Address - Country:US
Mailing Address - Phone:757-485-9349
Mailing Address - Fax:757-465-3639
Practice Address - Street 1:4335 SUNRAY AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2625
Practice Address - Country:US
Practice Address - Phone:757-485-9349
Practice Address - Fax:757-465-3639
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health