Provider Demographics
NPI:1508168931
Name:LUSSIER, TARA R C (CD, RYT, CHHC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:R C
Last Name:LUSSIER
Suffix:
Gender:F
Credentials:CD, RYT, CHHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MORRISETT CT SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-6140
Mailing Address - Country:US
Mailing Address - Phone:703-472-4704
Mailing Address - Fax:
Practice Address - Street 1:503 MORRISETT CT SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-6140
Practice Address - Country:US
Practice Address - Phone:703-472-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula