Provider Demographics
NPI:1396501177
Name:MENJIVAR, LIZ NAYRA
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:NAYRA
Last Name:MENJIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:NAYRA
Other - Last Name:ROCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:517 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4911
Mailing Address - Country:US
Mailing Address - Phone:804-783-2505
Mailing Address - Fax:
Practice Address - Street 1:517 W GRACE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4911
Practice Address - Country:US
Practice Address - Phone:804-783-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health