Provider Demographics
NPI:1629649975
Name:DUDLEY, LORA LEANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:LEANNE
Last Name:DUDLEY
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 1:203 JEFFERSON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2005
Mailing Address - Country:US
Mailing Address - Phone:434-610-2677
Mailing Address - Fax:
Practice Address - Street 1:2097 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1443
Practice Address - Country:US
Practice Address - Phone:434-200-3204
Practice Address - Fax:434-200-7468
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040130531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical