Provider Demographics
NPI:1821658147
Name:THOMAS, LERLENA JEANNETTE
Entity Type:Individual
Prefix:
First Name:LERLENA
Middle Name:JEANNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LERLENA
Other - Middle Name:JEANNETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11430 BRANT HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-8961
Mailing Address - Country:US
Mailing Address - Phone:804-617-3159
Mailing Address - Fax:804-318-1352
Practice Address - Street 1:4613 CHESTER SQUARE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1726
Practice Address - Country:US
Practice Address - Phone:804-617-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services