Provider Demographics
NPI:1952642084
Name:CAILLETEAU, VIRGINIA (LICSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:CAILLETEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 LACEY BLVD SE UNIT 3655
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-4033
Mailing Address - Country:US
Mailing Address - Phone:225-993-0787
Mailing Address - Fax:
Practice Address - Street 1:1204 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4277
Practice Address - Country:US
Practice Address - Phone:253-257-9137
Practice Address - Fax:360-785-2545
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0048641041C0700X
WALW608367681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical