Individual
LISANNE JENEL PADMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1411 PRINCESS ANNE ST, FREDERICKSBURG, VA 22401-3832
(540) 922-1110
Mailing address
526 HIGH ST APT 203, PETERSBURG, VA 23803-3832
(732) 713-0519
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S00000X
NONE
—
Enumeration date
06/11/2019
Last updated
06/11/2019
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