Provider Demographics
NPI:1780839274
Name:GREGOIRE, VIRGINIA MCCLELLAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MCCLELLAN
Last Name:GREGOIRE
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 1:2505 RHODES CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7613
Mailing Address - Country:US
Mailing Address - Phone:757-427-2023
Mailing Address - Fax:
Practice Address - Street 1:287 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2962
Practice Address - Country:US
Practice Address - Phone:757-490-6960
Practice Address - Fax:757-490-6995
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical