Provider Demographics
NPI:1083387500
Name:WASHINGTON-MORA, LISA DARLENE (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DARLENE
Last Name:WASHINGTON-MORA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1965 EMANCIPATION HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6213
Mailing Address - Country:US
Mailing Address - Phone:540-735-0560
Mailing Address - Fax:540-735-0567
Practice Address - Street 1:1965 EMANCIPATION HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6213
Practice Address - Country:US
Practice Address - Phone:540-735-0560
Practice Address - Fax:540-735-0567
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024182287363LP0808X
VA00224182287363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health