Provider Demographics
NPI:1902816069
Name:TREGELLAS WHITE, MELBA MCCLUNA (LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:MCCLUNA
Last Name:TREGELLAS WHITE
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:MRS
Other - First Name:MELBA
Other - Middle Name:MCCLUNA
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 HAMPTON HWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693
Mailing Address - Country:US
Mailing Address - Phone:757-865-1843
Mailing Address - Fax:757-865-7485
Practice Address - Street 1:205 HAMPTON HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693
Practice Address - Country:US
Practice Address - Phone:757-865-1843
Practice Address - Fax:757-865-7485
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040009531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA073630OtherANTHEM
VA8913021Medicaid