Provider Demographics
NPI:1295800233
Name:GRETT, RONNIE D (LCSW)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:D
Last Name:GRETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 GREENBRIER CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2640
Mailing Address - Country:US
Mailing Address - Phone:757-547-9007
Mailing Address - Fax:757-962-5799
Practice Address - Street 1:860 GREENBRIER CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2640
Practice Address - Country:US
Practice Address - Phone:757-547-9007
Practice Address - Fax:757-962-5799
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009298C87Medicare ID - Type Unspecified