Provider Demographics
NPI:1861532517
Name:GREGORY, MOLLY LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:LOUISE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8296 OLD COURTHOUSE ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-917-8681
Mailing Address - Fax:703-336-8342
Practice Address - Street 1:8296 OLD COURTHOUSE ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-917-8681
Practice Address - Fax:703-336-8342
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040015601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4139955OtherAETNA
VA096489OtherTRIGON
GR651182Medicare ID - Type Unspecified
VA096489OtherTRIGON