Provider Demographics
NPI:1508010232
Name:L R MINOR LLC
Entity Type:Organization
Organization Name:L R MINOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-361-4330
Mailing Address - Street 1:910 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5844
Mailing Address - Country:US
Mailing Address - Phone:540-656-2106
Mailing Address - Fax:540-656-2107
Practice Address - Street 1:910 PRINCESS ANNE ST
Practice Address - Street 2:SUITE 109
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5844
Practice Address - Country:US
Practice Address - Phone:540-656-2106
Practice Address - Fax:540-656-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002023261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA291952OtherBLUE CROSS BLUE SHIELD
VA80000284OtherMEDICARE ID-TYPE UNSPECIFIED
VA089122OtherSENTARA-VETRI
VA512334OtherNCPPO
VA461682000OtherMIS
VA89-1497-4Medicaid
VA152672OtherMHN
VA4763-0001OtherCARE FIRST BCBS