Provider Demographics
NPI:1275266520
Name:LEMICH CLINIC
Entity Type:Organization
Organization Name:LEMICH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LEMICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:240-247-7399
Mailing Address - Street 1:1809 ARA ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4101
Mailing Address - Country:US
Mailing Address - Phone:240-247-7399
Mailing Address - Fax:
Practice Address - Street 1:5215 COLLEY AVE STE 113
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2166
Practice Address - Country:US
Practice Address - Phone:757-536-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699349365OtherNPI