Provider Demographics
NPI:1952828329
Name:NIELSEN, LISA (CFCS-HDFS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:CFCS-HDFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 MAIDEN LN SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2208
Mailing Address - Country:US
Mailing Address - Phone:540-293-7516
Mailing Address - Fax:
Practice Address - Street 1:2112 MAIDEN LANE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015
Practice Address - Country:US
Practice Address - Phone:540-293-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency