Provider Demographics
NPI:1518303056
Name:LOTUS PLACE, LLC
Entity Type:Organization
Organization Name:LOTUS PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SHREVE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:304-612-1582
Mailing Address - Street 1:5000 GREENBAG ROAD, UNIT E7
Mailing Address - Street 2:MOUNTAINEER MALL
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501
Mailing Address - Country:US
Mailing Address - Phone:304-612-1582
Mailing Address - Fax:
Practice Address - Street 1:5000 GREENBAG ROAD,
Practice Address - Street 2:UNIT E7
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2411
Practice Address - Country:US
Practice Address - Phone:304-612-1582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1896261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health