Provider Demographics
NPI:1629419569
Name:MCDONALD, LACREASIA DARNESSA (MED)
Entity Type:Individual
Prefix:MS
First Name:LACREASIA
Middle Name:DARNESSA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 ROCK BRIDGE MEWS
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7444
Mailing Address - Country:US
Mailing Address - Phone:757-449-8678
Mailing Address - Fax:
Practice Address - Street 1:1717 ROCK BRIDGE MEWS
Practice Address - Street 2:UNIT A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7444
Practice Address - Country:US
Practice Address - Phone:757-449-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist