Provider Demographics
NPI:1962681288
Name:ASGAARD, GREGORY LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:ASGAARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GATEWAY CT
Mailing Address - Street 2:APT. # 209
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5076
Mailing Address - Country:US
Mailing Address - Phone:618-203-1050
Mailing Address - Fax:
Practice Address - Street 1:105 GATEWAY CT
Practice Address - Street 2:APT. # 209
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5076
Practice Address - Country:US
Practice Address - Phone:618-203-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9999999999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical