Provider Demographics
NPI:1265980288
Name:LOUREY, LISA (LAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOUREY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9143 SILVERSHADOW CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5208
Mailing Address - Country:US
Mailing Address - Phone:703-209-3524
Mailing Address - Fax:
Practice Address - Street 1:5627 ALLENTOWN RD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4520
Practice Address - Country:US
Practice Address - Phone:703-209-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02361171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist