Provider Demographics
NPI:1427376946
Name:GREGG-MARTIN, ANDREA RENEA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RENEA
Last Name:GREGG-MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3500 KENSINGTON AVE
Mailing Address - Street 2:E
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2144
Mailing Address - Country:US
Mailing Address - Phone:804-377-3955
Mailing Address - Fax:804-377-3956
Practice Address - Street 1:3500 KENSINGTON AVE
Practice Address - Street 2:E
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2144
Practice Address - Country:US
Practice Address - Phone:804-377-3955
Practice Address - Fax:804-377-3956
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional