Provider Demographics
NPI:1114539780
Name:LITE AND FREE, INC.
Entity Type:Organization
Organization Name:LITE AND FREE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:804-991-4197
Mailing Address - Street 1:9157 ATLEE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2504
Mailing Address - Country:US
Mailing Address - Phone:804-991-4197
Mailing Address - Fax:804-723-5421
Practice Address - Street 1:9157 ATLEE RD STE A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2504
Practice Address - Country:US
Practice Address - Phone:804-991-4197
Practice Address - Fax:804-723-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14563827OtherCAQH