1316725708 NPI number — MRS. SHELLI CLEMENS LORD-PAWSON PEERRECOVERYSPECIALI

Table of content: MRS. SHELLI CLEMENS LORD-PAWSON PEERRECOVERYSPECIALI (NPI 1316725708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316725708 NPI number — MRS. SHELLI CLEMENS LORD-PAWSON PEERRECOVERYSPECIALI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORD-PAWSON
Provider First Name:
SHELLI
Provider Middle Name:
CLEMENS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PEERRECOVERYSPECIALI
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:
1316725708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ADOLESCENT & FAMILY HEALTH CENTER
Provider Second Line Business Mailing Address:
13821 VILLAGE MILL DRIVE, SUITE B
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:
804-794-8900
Provider Business Mailing Address Fax Number:
804-378-2012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ADOLESCENT & FAMILY HEALTH CENTER
Provider Second Line Business Practice Location Address:
13821 VILLAGE MILL DRIVE, SUITE B
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-794-8900
Provider Business Practice Location Address Fax Number:
804-378-2012
Provider Enumeration Date:
09/18/2023

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: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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