Provider Demographics
NPI:1427706233
Name:LA-NP PSYCHIATRIC MENTAL-HEALTH , PLC
Entity type:Organization
Organization Name:LA-NP PSYCHIATRIC MENTAL-HEALTH , PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:OLANDA
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:NP- PSYCHIATRIC MH
Authorized Official - Phone:856-404-5794
Mailing Address - Street 1:11900 TIDELINE CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-5437
Mailing Address - Country:US
Mailing Address - Phone:856-404-5794
Mailing Address - Fax:
Practice Address - Street 1:11900 TIDELINE CIR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-5437
Practice Address - Country:US
Practice Address - Phone:856-404-5794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty