Provider Demographics
NPI:1285058438
Name:LAMAR, CONNIE (RN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:LAMAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20165 OFFICE CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-3197
Mailing Address - Country:US
Mailing Address - Phone:302-854-0677
Mailing Address - Fax:
Practice Address - Street 1:20165 OFFICE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-3197
Practice Address - Country:US
Practice Address - Phone:302-854-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0039528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health