Provider Demographics
NPI:1417442179
Name:ROSS, LAUREN NICOLE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 85073
Mailing Address - Street 2:#47141
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23285-5073
Mailing Address - Country:US
Mailing Address - Phone:305-846-9807
Mailing Address - Fax:
Practice Address - Street 1:4828 HARBOR OAKS WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-1944
Practice Address - Country:US
Practice Address - Phone:305-846-9807
Practice Address - Fax:305-846-9711
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst