Healthcare Provider Details

I. General information

NPI: 1679494603
Provider Name (Legal Business Name): LINDSEY NICOLE GRUBER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 S PLAZA TRL STE 101
VIRGINIA BEACH VA
23452-1931
US

IV. Provider business mailing address

521 LASKIN RD APT 324
VIRGINIA BEACH VA
23451-3995
US

V. Phone/Fax

Practice location:
  • Phone: 757-933-1636
  • Fax:
Mailing address:
  • Phone: 724-877-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004996
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: