Provider Demographics
NPI:1164138731
Name:DRLULLABY LLC
Entity Type:Organization
Organization Name:DRLULLABY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MEDALIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-997-5759
Mailing Address - Street 1:1440 W TAYLOR ST # 556
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:844-475-3379
Mailing Address - Fax:
Practice Address - Street 1:9230 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4201
Practice Address - Country:US
Practice Address - Phone:844-475-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRLULLABY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-26
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty