Organization
L R MINOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA R MINOR LCSW (PRESIDENT)
(540) 361-4330
Entity
Organization
Contact information
Practice address
910 PRINCESS ANNE ST, SUITE 109, FREDERICKSBURG, VA 22401-5844
(540) 656-2106
(540) 656-2107
Mailing address
910 PRINCESS ANNE ST, SUITE 109, FREDERICKSBURG, VA 22401-5844
(540) 656-2106
(540) 656-2107
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0904002023
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089122
SENTARA-VETRI
VA
01
—
152672
MHN
VA
01
—
291952
BLUE CROSS BLUE SHIELD
VA
01
—
461682000
MIS
VA
01
—
4763-0001
CARE FIRST BCBS
VA
01
—
512334
NCPPO
VA
01
—
80000284
MEDICARE ID-TYPE UNSPECIFIED
VA
05
—
89-1497-4
—
VA
Enumeration date
11/07/2008
Last updated
11/02/2010
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