1003966946 NPI number — MS. LYNN MARIE FRITTS

Table of content: MS. LYNN MARIE FRITTS (NPI 1003966946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003966946 NPI number — MS. LYNN MARIE FRITTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRITTS
Provider First Name:
LYNN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLE
Provider Other First Name:
LYNN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003966946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13520 PENNSBORO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20151-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-505-0521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 N SAINT ASAPH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-838-6400
Provider Business Practice Location Address Fax Number:
703-838-5062
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701003871 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)