Provider Demographics
NPI:1538693007
Name:LISA NAZWORTH LLC
Entity Type:Organization
Organization Name:LISA NAZWORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:NAZWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-221-5646
Mailing Address - Street 1:3781 WESTERRE PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1328
Mailing Address - Country:US
Mailing Address - Phone:804-221-5646
Mailing Address - Fax:
Practice Address - Street 1:3781 WESTERRE PKWY STE F
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1328
Practice Address - Country:US
Practice Address - Phone:804-221-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040087351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty