Individual
JALIEEN LACYE GROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
500 OLD LYNCHBURG RD, CHARLOTTESVILLE, VA 22903-6500
(434) 972-1800
Mailing address
105 STEWART CIR APT B, CHARLOTTESVILLE, VA 22903-2018
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
06/04/2019
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