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Individual

DR. THERESA ANN LICHTMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
21000 EDUCATION CT, BROADLANDS, VA 20148
(572) 252-2214
Mailing address
21000 EDUCATION CT, BROADLANDS, VA 20148-5526
(572) 252-2214

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0810002799
VA
103TS0200X
School Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
192046
ANTHEM PPO
VA
Enumeration date
07/08/2006
Last updated
05/23/2018
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