Provider Demographics
NPI:1962478669
Name:GREGOIRE, DEEDEE (LCSW)
Entity Type:Individual
Prefix:
First Name:DEEDEE
Middle Name:
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1385
Mailing Address - Country:US
Mailing Address - Phone:409-772-2166
Mailing Address - Fax:409-772-2663
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555
Practice Address - Country:US
Practice Address - Phone:409-772-2166
Practice Address - Fax:409-772-2663
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGREGO-0003OtherCOMPCARE
TX038924902Medicaid
TX316877OtherMHN
TX788951000OtherMAGELLAN
TX0016RKOtherBLUE CROSS BLUE SHIELD
TX0016RKOtherBLUE CROSS BLUE SHIELD
TX800008030Medicare ID - Type UnspecifiedRAILROAD MEDICARE