Provider Demographics
NPI:1548855158
Name:GREGORY, CONSUELA DONYEA (BS)
Entity type:Individual
Prefix:
First Name:CONSUELA
Middle Name:DONYEA
Last Name:GREGORY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:CONSUELA
Other - Middle Name:DONYEA
Other - Last Name:TURPIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS
Mailing Address - Street 1:431 MICHAUX BRANCH TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6862
Mailing Address - Country:US
Mailing Address - Phone:559-367-8452
Mailing Address - Fax:
Practice Address - Street 1:1201 BOAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA51728225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist