Provider Demographics
NPI:1356638738
Name:DUBIQUE, ESTHER (LCSW)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:DUBIQUE
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 1:1385 FORDHAM DR STE 105-199
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5345
Mailing Address - Country:US
Mailing Address - Phone:757-971-3715
Mailing Address - Fax:
Practice Address - Street 1:5286 WALLER CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5452
Practice Address - Country:US
Practice Address - Phone:757-713-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6256101YM0800X
104100000X
VA09040095871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA21062003000416Medicaid
VA1356638738Medicaid
PVM2447OtherPROVIDER TRANSACTION NUMBER (PTAN)