Provider Demographics
NPI:1639528227
Name:SMITH, LISA CHRISTINA (LAC, DOM)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:CHRISTINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8361
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-0361
Mailing Address - Country:US
Mailing Address - Phone:804-497-8860
Mailing Address - Fax:804-377-2223
Practice Address - Street 1:9210 FOREST HILL AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6880
Practice Address - Country:US
Practice Address - Phone:804-497-8860
Practice Address - Fax:804-377-2223
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist