Provider Demographics
NPI:1568348977
Name:PETRA MCDONALD, LCSW, LLC
Entity type:Organization
Organization Name:PETRA MCDONALD, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-816-2921
Mailing Address - Street 1:2200 COLONIAL AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1919
Mailing Address - Country:US
Mailing Address - Phone:757-937-5780
Mailing Address - Fax:757-937-5780
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:757-937-5780
Practice Address - Fax:757-937-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health