Provider Demographics
NPI:1881194181
Name:GALADRIEL WINSTEAD, PSY.D., LLC
Entity Type:Organization
Organization Name:GALADRIEL WINSTEAD, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALADRIEL
Authorized Official - Middle Name:SALINA
Authorized Official - Last Name:WINSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-486-6955
Mailing Address - Street 1:120 S LYNNHAVEN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7419
Mailing Address - Country:US
Mailing Address - Phone:757-486-6955
Mailing Address - Fax:757-486-3258
Practice Address - Street 1:120 S LYNNHAVEN RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7419
Practice Address - Country:US
Practice Address - Phone:757-486-6955
Practice Address - Fax:757-486-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810004332OtherLICENSE NUMBER
VA1588724231Medicaid