Provider Demographics
NPI:1679245138
Name:LACHAPELLE NILSSON, FANNY
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:
Last Name:LACHAPELLE NILSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 W CLAY ST APT 704B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4665
Mailing Address - Country:US
Mailing Address - Phone:804-248-2430
Mailing Address - Fax:
Practice Address - Street 1:3410 W CLAY ST APT 704B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4665
Practice Address - Country:US
Practice Address - Phone:804-248-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty