Provider Demographics
NPI:1154001600
Name:GREGORY-HOLBERG, DIEHDRE (LPC)
Entity type:Individual
Prefix:
First Name:DIEHDRE
Middle Name:
Last Name:GREGORY-HOLBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 MAIDENS RD
Mailing Address - Street 2:
Mailing Address - City:MAIDENS
Mailing Address - State:VA
Mailing Address - Zip Code:23102-2120
Mailing Address - Country:US
Mailing Address - Phone:757-967-7707
Mailing Address - Fax:
Practice Address - Street 1:2404 MAIDENS RD
Practice Address - Street 2:
Practice Address - City:MAIDENS
Practice Address - State:VA
Practice Address - Zip Code:23102-2120
Practice Address - Country:US
Practice Address - Phone:757-967-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional