1437305554 NPI number — MRS. NINA CONSALVI LACKEY LPC, CSAC

Table of content: MRS. NINA CONSALVI LACKEY LPC, CSAC (NPI 1437305554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437305554 NPI number — MRS. NINA CONSALVI LACKEY LPC, CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACKEY
Provider First Name:
NINA
Provider Middle Name:
CONSALVI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CSAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437305554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14201 CAMACK TRL.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-840-5457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6767 FOREST HILL AVE
Provider Second Line Business Practice Location Address:
SUITE #306
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-840-5457
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2008

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: 101YA0400X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 0701001911 , 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)