Provider Demographics
NPI:1619695525
Name:GRAGG, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GRAGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16596 CHESTNUT OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-2869
Mailing Address - Country:US
Mailing Address - Phone:703-728-3879
Mailing Address - Fax:
Practice Address - Street 1:16596 CHESTNUT OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-2869
Practice Address - Country:US
Practice Address - Phone:703-728-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health