Provider Demographics
NPI:1154503217
Name:MAGAZINE, LISA BETHANY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BETHANY
Last Name:MAGAZINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 COMMONS DR
Mailing Address - Street 2:STE #103
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2528
Mailing Address - Country:US
Mailing Address - Phone:804-722-0620
Mailing Address - Fax:804-722-0621
Practice Address - Street 1:6610 COMMONS DR
Practice Address - Street 2:STE #103
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2528
Practice Address - Country:US
Practice Address - Phone:804-722-0620
Practice Address - Fax:804-722-0621
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical