Individual
JALIEEN LACYE GROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3003 HOLLINS RD NE, ROANOKE, VA 24012-7505
(540) 266-9200
Mailing address
4136 MUDLICK RD SW, ROANOKE, VA 24018-2042
(540) 430-6606
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701007964
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942270699
—
VA
Enumeration date
06/04/2019
Last updated
05/11/2026
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