Provider Demographics
NPI:1821039819
Name:GROSSE, RICHARD FRANK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FRANK
Last Name:GROSSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:703 N COURTHOUSE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4069
Mailing Address - Country:US
Mailing Address - Phone:804-794-4482
Mailing Address - Fax:804-379-7578
Practice Address - Street 1:703 N COURTHOUSE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4069
Practice Address - Country:US
Practice Address - Phone:804-794-4482
Practice Address - Fax:804-379-7578
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010115370Medicaid
VA010115370Medicaid