Provider Demographics
NPI:1366891905
Name:LORALIE GRIGAS MSW LCSW LCAS PLLC
Entity type:Organization
Organization Name:LORALIE GRIGAS MSW LCSW LCAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LORALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCAS
Authorized Official - Phone:910-617-4675
Mailing Address - Street 1:PO BOX 16329
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-6329
Mailing Address - Country:US
Mailing Address - Phone:910-617-4675
Mailing Address - Fax:910-469-0480
Practice Address - Street 1:1328 LAKE PARK BLVD N STE 108E
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3906
Practice Address - Country:US
Practice Address - Phone:910-617-4675
Practice Address - Fax:910-469-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-05
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0069831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty