Provider Demographics
NPI:1477438265
Name:MCDONALD, PETRA (LCSW)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 LAKE CONRAD CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2016
Mailing Address - Country:US
Mailing Address - Phone:757-816-2921
Mailing Address - Fax:
Practice Address - Street 1:2200 COLONIAL AVE STE 12
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1919
Practice Address - Country:US
Practice Address - Phone:757-816-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040189171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical