Provider Demographics
NPI:1982682282
Name:HURLEY, VIRGINIA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:HURLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:104 BAYTREE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6107
Mailing Address - Country:US
Mailing Address - Phone:252-258-1944
Mailing Address - Fax:252-353-4967
Practice Address - Street 1:2317 EXECUTIVE CIR
Practice Address - Street 2:PERSONALIZED THERAPY, INC.
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3762
Practice Address - Country:US
Practice Address - Phone:252-353-4968
Practice Address - Fax:252-353-4967
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002413Medicaid
NC800013622OtherRAILROAD MEDICARE
NC13293OtherBCBS NC
NC2874988Medicare ID - Type Unspecified
NCP68418Medicare UPIN