Provider Demographics
NPI:1700491727
Name:STORY, MICHELLE R (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:STORY
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 1:3904 PEYTON WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1576
Mailing Address - Country:US
Mailing Address - Phone:757-348-8537
Mailing Address - Fax:
Practice Address - Street 1:4453 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2821
Practice Address - Country:US
Practice Address - Phone:757-231-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040120161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904012016OtherVIRGINIA DEPT OF HEALTH PROFESSIONS LCSW