Provider Demographics
NPI:1215081104
Name:ROY, GRETCHEN LYNNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:LYNNE
Last Name:ROY
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:PO BOX 6023
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71307-6023
Mailing Address - Country:US
Mailing Address - Phone:318-442-7482
Mailing Address - Fax:
Practice Address - Street 1:242 WEST SHAMROCK AVENUE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71477-7473
Practice Address - Country:US
Practice Address - Phone:318-484-6914
Practice Address - Fax:318-484-6844
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical