=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932254448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY R GREGOIRE DCSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 06/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 362 MCLAWS CIR STE 2
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185-5648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-504-7393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 448
-----------------------------------------------------
City | LIGHTFOOT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23090-0448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-504-7393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C005114
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904001877
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------