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Individual

LISA S ROSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
10710 MIDLOTHIAN TPKE STE 127, NORTH CHESTERFIELD, VA 23235-4776
(673) 780-4207
Mailing address
10710 MIDLOTHIAN TPKE STE 127, NORTH CHESTERFIELD, VA 23235-4776
(804) 207-6737

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701012117
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30017644370001
VA
Enumeration date
01/26/2023
Last updated
11/28/2023
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