Provider Demographics
NPI:1780242164
Name:MOMPREMIER, LANINA ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:LANINA
Middle Name:ELIZABETH
Last Name:MOMPREMIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 ROCKBRIDGE RD. SW
Mailing Address - Street 2:STE 208, BOX 364
Mailing Address - City:STONE MOUTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:240-339-3518
Mailing Address - Fax:
Practice Address - Street 1:5011 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30087-3289
Practice Address - Country:US
Practice Address - Phone:240-339-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08100004543103TC0700X
MD05139103TC0700X
DCPSY1000830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical