Provider Demographics
NPI:1174113443
Name:BOURGEOIS, CLAUDIA DIANE (LPC)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:DIANE
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CLAUDIA
Other - Middle Name:DIANE
Other - Last Name:BRASSIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:5205 NUTHALL DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3755
Mailing Address - Country:US
Mailing Address - Phone:757-270-6799
Mailing Address - Fax:
Practice Address - Street 1:7460 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2818
Practice Address - Country:US
Practice Address - Phone:757-270-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional