Provider Demographics
NPI:1912748542
Name:GREGOIRE, AUDREY NOELLE (MSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:NOELLE
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 IONA SOUND DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1921
Mailing Address - Country:US
Mailing Address - Phone:571-393-9750
Mailing Address - Fax:
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 255
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3096
Practice Address - Country:US
Practice Address - Phone:703-712-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060154601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical