Provider Demographics
NPI:1780176990
Name:LAVERTY, TRINA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:MICHELLE
Last Name:LAVERTY
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 1:2208 EXECUTIVE DR STE A-E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6603
Mailing Address - Country:US
Mailing Address - Phone:757-826-7516
Mailing Address - Fax:757-826-6232
Practice Address - Street 1:2208 EXECUTIVE DR STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6603
Practice Address - Country:US
Practice Address - Phone:757-826-7516
Practice Address - Fax:757-826-6232
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical