Provider Demographics
NPI:1528021193
Name:KERN, LAURI ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURI
Middle Name:ANN
Last Name:KERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7332
Mailing Address - Country:US
Mailing Address - Phone:757-468-0550
Mailing Address - Fax:757-468-9992
Practice Address - Street 1:780 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 400 ATLANTIC PSYCHIATRIC SERVICES
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-468-0550
Practice Address - Fax:757-468-9992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040058411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
261288OtherCOM PSYCH
89038MOtherSENTARA OPTIMA
184036OtherANTHEM PPO