Provider Demographics
NPI:1851551311
Name:GREGORY, MALVOLIA LA FRANCES (LPC (IN TRAINING))
Entity Type:Individual
Prefix:MRS
First Name:MALVOLIA
Middle Name:LA FRANCES
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LPC (IN TRAINING)
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Mailing Address - Street 1:11230 WAPLES MILL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6087
Mailing Address - Country:US
Mailing Address - Phone:703-208-1500
Mailing Address - Fax:703-208-1540
Practice Address - Street 1:11230 WAPLES MILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6087
Practice Address - Country:US
Practice Address - Phone:703-208-1500
Practice Address - Fax:703-208-1540
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional