Provider Demographics
NPI:1063020170
Name:CONNELLY, LAUREN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:8005 CREIGHTON PKWY STE C #202
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4954
Mailing Address - Country:US
Mailing Address - Phone:804-442-6302
Mailing Address - Fax:
Practice Address - Street 1:1900 BYRD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3033
Practice Address - Country:US
Practice Address - Phone:592-631-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00241794392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024179439OtherNURSE PRACTITIONER LICENSE NUMBER
2020007827OtherAMERICAN NURSES CREDENTIALING CENTER