Provider Demographics
NPI:1699109611
Name:CARRIGAN, GREGORY MICHAEL (LGSW)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:CARRIGAN
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2734
Mailing Address - Country:US
Mailing Address - Phone:703-268-3259
Mailing Address - Fax:
Practice Address - Street 1:3154 STRATFORD COURT
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124
Practice Address - Country:US
Practice Address - Phone:703-268-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16895104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker